Fulbright Commission UK Summer Institute Draft Application 2015

*Please note: We highly recommend you use this form as an opportunity to create a rough draft of your
application for your records and use. This form is almost a complete replica of the online application form. You
must submit an online application via the link from the programme website, and send the supplemental
materials to the listed e-mail in order to apply. Please be sure you have reviewed the webpages and
application instructions for details before beginning your online application.
Programme Details
Which institute are you applying for? You may only state one

Personal Details
Title:
Last Name:

First Name:

Permanent Address:

Term Time Address:

Is this your primary contact address? Yes

Zip Code:
State:
Telephone:

Middle Name(s):

No

Cell Phone:

Place of Birth:

Is this your primary contact address? Yes

Zip Code:
State:

No

Email Address:
Citizenship (s):

Current Academic Details

Current Academic Institution:
Address:

Degree Programme/Major & Minor:

Present Academic Level (tick one):
Freshman (Rising Sophomore)
Sophomore (Rising Junior)

Zip Code:

State:

Expected Graduation Date (month/year):

Current GPA:

Emergency Contact Details

The emergency contact data will be used only for emergency purposes e.g. in the event of an accident whilst
on the programme. You should notify the individual you have named below that you have provided us with this
information and we will hold this information on file, if you are selected. The emergency contact will only be
disclosed in emergency situations to appropriate 3rd parties, e.g. ambulance service, hospital and the police, in
your immediate health or safety interests. Please notify the Commission immediately if this information
changes.
Name:
Relationship to you:
Address:

Telephone:
Cell Phone:
Email Address:

Zip Code:

State:

Have you ever travelled outside of the United States? Yes

If yes, please list all countries: (attach a separate sheet if necessary)

No

Date

Country

Length of stay

Reason for travel (e.g. school

trip/ vacation/ visit family)

Have you ever attended a Summer School before?

Yes

No

If yes, please list the programme name, year and location:

US Passport
All participants must have a valid US passport to take part in the Summer Institute. Please confirm that you
have a valid US passport that will still be in date 6 months after you return from the programme (i.e. until end of
Feb 2016). Please be advised that the process for applying for a US passport can take between four and six
weeks.
Yes

No

In progress

How far along are you in the process?

Extra-curricular Activities
Please list all extra-curricular activities from the last four years: (attach one separate sheet if necessary)
Date From

Date To

Organisation

Position Held/Award Given and Duties/Description

Self-Assessment: Assessing Yourself by Threes

Please complete this section fully; there are no trick questions or correct answers.
What are three areas in your life that you are passionate about?
1.

2.

3.

What are three things that you would change about your life if you could?
1.

2.

3.

What are your three best qualities?

1.

2.

3.

What are your three greatest weaknesses?

1.

2.

3.

List three adjectives to describe yourself

1.

2.

3.

How do you think your friends would describe you?

Write about the nicest thing that you have ever done to help someone else

Write about a time that you let someone else down and how you feel about it now

What qualities or skills do you have to offer to your host institution community?

All applicants:
Please read the following section carefully along with the application instructions; applications that are
incomplete or missing any required supplemental materials will not be considered.

Personal Statement
Please complete a personal statement. Please make sure you discuss why you are interested in studying in the
United Kingdom and what you hope to gain from the experience.
Essay Question
Please complete an essay on the following pages based on one of the questions below:
1. Using one or more examples, please discuss a current affairs issue in the United States that is
important to you.
2. Describe a situation in which you have had significant responsibility and what you learnt from it.
3. Describe something that you have observed or experienced which has had a significant impression on
you.
4. Think of a time when you have found something particularly challenging. How did you approach that
situation and what steps did you take to overcome those challenges?
Academic Transcript/Confirmation of Grades and References
Please refer to the website, application instructions and FAQs for more information on Transcripts and
Reference letters.

Personal Statement
Please make sure that you review the detailed instructions to complete the personal statement. Your personal
statement must not be longer than the space this box permits.

Essay Question
Please make sure that you review the detailed instructions to complete the essay. Your essay must not be
longer than the space this box permits. Please indicate which essay question you have answered.
Essay number:

Equal Opportunities Monitoring Form: UKSI 2015

The Fulbright Commission is committed to the promotion of equality of opportunity in all aspects of its policy,
practices and procedures. To make this meaningful we need to monitor the effectiveness of our policies, by
analysing statistical information. We would be grateful if you could provide us with the following information,
which will ensure our statistics are accurate and representative of people who are seeking programmes and
awards through the Fulbright Commission.
This form will be kept separate from your application form and treated in the strictest confidence. The
information you provide will not be used as part of the recruitment selection process. It will only be viewed after
your interview by the programme administrator, if you are successful in obtaining a place on the programme to
complete your application with the host university and for statistical purposes.
Last Name:

First Name:

Gender:
Male
Female

Date of Birth (dd/mm/yyyy)

/ /
Age at start of the programme

Middle Name(s):

Prefer not to say

Ethnic Group
Tick the appropriate box to indicate your ethnic background
White
African American and White
Black or African American
Asian American and White
Asian or American Asian
Hispanic and White
Hispanic or Latino
American Indian and White
Native American or Alaskan Native
African American and Hispanic
Native Hawaiian & Other Pacific Islander
African American and Asian
Other ethnic background
Please specify:
Parent/Guardian Education
Tick the appropriate box to indicate the highest level of education achieved by your parents/guardians
High School
Associate Degree
Bachelors Degree
Postgraduate Degree
None
Prefer not to say
Disability
Do you consider yourself to be disabled?
Yes
No
Prefer not to say

Programme Promotion
Where did you see/hear about this programme?
Fulbright Commission Website
Flyer or Poster
Word of Mouth
Previous Applicant
Email
Academic Advisor

The organisers of the programme have requested information regarding any medical, physical, dietary or other
personal considerations that any successful applicants would require. This will not affect candidate selection,
but will enable the host institution to make any necessary accommodations.
Please detail any relevant information below, or if you prefer these considerations can be discussed if you are
successful after the interview.

Confirmation of Documentation
Please use this checklist to confirm that you have completed all of the following sections and included all of the
necessary documents in your email. Incomplete applications will not be considered by the Commission.
UK Summer Institute Application Form
Self-Assessment: Assessing Yourself by Threes
Personal Statement
Essay Question
Equal Opportunities Monitoring Form
Academic Transcript
Two Letters of Reference
Any questions, please e-mail:
programmes@fulbright.org.uk
Applications must be received in full by:
February 26 or March 5 (depending on your programme choice) by 5pm (UK Time)
Late applications will not be considered under any circumstances.