2015 Humphrey Application Form

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
APPLICATION FOR ADMISSION TO THE
HUBERT H. HUMPHREY FELLOWSHIP PROGRAM- 2015-2016
FOR MID-CAREER PROFESSIONAL DEVELOPMENT IN THE UNITED STATES
Information and Application Instructions
PROGRAM DESCRIPTION: The Humphrey Fellowship Program provides mid-career professionals from designated countries
of Africa, Asia, Latin America, the Caribbean, the Middle East, Europe and Eurasia with an opportunity to enhance their
professional capabilities through participation in specialized, 10-month, non degree programs developed specifically for small
clusters of Humphrey Fellows at selected U.S. universities. The Humphrey Program was initiated in 1978 to honor the memory
and accomplishments of the late Senator and Vice President, Hubert H. Humphrey. Fellows are selected based on their
potential for national leadership and commitment to public service, in either the public or private sector. The program provides a
basis for establishing long-lasting productive partnerships and relationships between citizens of the United States and their
professional counterparts in other countries, fostering an exchange of knowledge and mutual understanding throughout the
world.
Funding for the Humphrey Program is provided by the U.S. government through the United States Department of State and
other co-sponsors. The Institute of International Education (IIE) collaborates with the State Department's Bureau of Educational
and Cultural Affairs in administering the program. The types of university programs arranged for Humphrey Fellows depart from
a traditional discipline-oriented focus and have a problem-solving and experience-sharing emphasis. The programs are not
degree-related or aimed at providing scholarly preparation or basic training in a field. The objective is to provide Humphrey
Fellows with an overall experience that broadens their perspectives, enhances their capability to assume greater career
responsibilities, and provides opportunities to establish useful professional contacts. To accomplish these objectives, programs
are designed to include various combinations of course work, independent projects, internships, consultations with U.S. faculty
or experts, field trips, and special seminars. Under the guidance of a designated faculty advisor or “coordinator,” Fellows plan
programs that best suit their individual career development needs.
DURATION OF GRANT: The program arranged for Humphrey Fellows extends from August or early September to the following
June. Applicants who need additional English training may be required to arrive in the United States as early as April for
intensive language study before beginning their regular university program. Candidates must be able to participate in the full
period of the English and/or university programs.
NONDEGREE STATUS: The program designed for Humphrey Fellows does not result in the awarding of a degree. While
Fellows are able to enroll in courses relevant to their professional interests, the Humphrey Program is not appropriate for
those who wish to concentrate on academic work required for a U.S. degree. Humphrey Fellows spend a considerable
portion of their time engaged in off-campus activities such as internships, field trips, workshops, and special projects that give
them practical experience in their professional fields. Fellows who successfully complete the program are awarded a Certificate
of Participation.
FINANCIAL PROVISIONS: The Humphrey Fellowship provides a monthly maintenance allowance, a book and supplies
allowance, tuition and fees when applicable, round-trip international travel to the host institution (and to the Fellow’s English-
language training program when applicable) and domestic travel to Washington, D.C. for a special seminar. Supplementary
funds are provided for professional activities such as field trips or attendance at conferences. Humphrey Fellowships are not
renewable.
Humphrey Fellows should plan to bring with them some personal funds to cover incidental expenses not covered in the grant.
Humphrey Fellowships do not include funds for dependents (family members). Humphrey Fellows are responsible for providing
travel, insurance, and financial support for any dependents accompanying them in the United States. Please note that English
and orientation centers cannot accommodate dependents. Therefore, dependents should not arrive in the United States until the
Fellows are settled in their academic year programs and have secured housing (at least 30 days after the Fellow’s arrival) at the
host campus.
1
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
PROGRAM FIELDS: The programs arranged for Humphrey Fellows are related to one of the following fields: agricultural
development/agricultural economics; communications/journalism; economic development/finance and banking; educational
administration, planning and policy; HIV/AIDS policy and prevention; human resource management; law and human rights;
natural resources and environmental management; public health policy and management; public policy analysis and public
administration; substance abuse education, treatment and prevention; teaching of English as a foreign language; technology
policy and management; trafficking in persons, policy and prevention; urban and regional planning. The university programs do
not address themselves to the scientific or technical aspects of these fields, but rather to broad policy-making and problem-
solving issues.
PLACEMENT IN UNIVERSITY PROGRAMS: Candidates who are selected for fellowships are placed in clusters by field of
interest at U.S. universities specially designated to host a group of Humphrey Fellows. IIE, therefore, is not able to make
placements at specific universities requested by candidates, or to award fellowships enabling candidates to attend a U.S.
university on the basis that they have already been admitted. Candidates should not apply directly to U.S. institutions.
APPLICATION INSTRUCTIONS:
1. Each page of the enclosed application carries its own instructions and should be read carefully before proceeding. All forms
must be completed in English and typewritten or computer-generated. Please answer every question as completely as
possible (except for the Substance Abuse form, page 5A of the application, which should only be completed by candidates in
the field of substance abuse).
2. Please take special notice of #13, "Give a 50-word summary of your proposed program plan." This section is very
important as members of the J. William Fulbright Scholarship Board read this summary and determine whether to approve
Humphrey nominations. Please be sure to provide a succinct but substantive summary statement.
3. The completed application must be returned to the office or nomination committee in your home country according to the
instructions provided by them. (Do not submit the application to IIE.)
4. You must attach complete and certified academic documents covering your entire period of study at universities or
other postsecondary institutions, including advanced degrees. Documents must be accompanied by complete
English translations.
Your academic documents must consist of:
• A certified official record (transcript) from each university or other postsecondary institution, listing the subjects you
studied and the grades (marks) you received during each year of your enrollment. Include all postsecondary institutions
you attended, even those from which you did not receive a degree or diploma.
• Certified, official evidence of each postsecondary or university degree, diploma, or certificate awarded to you.
To be considered official, each academic document must bear the seal of the issuing institution as well as the signature
of its officials. Copies of original documents will be accepted only if they are separately certified as being authentic duplicates
of originals. Certification of copies may be made by the issuing institution, by your selection committee, or by a U.S. consular
official.
5. You are required to submit two letters of reference, one of which must be from your immediate supervisor in your
current position. The letters of reference should be written in English or should include an English translation.
6. Important information about TOEFL: The Test of English as a Foreign Language (TOEFL) is required by all U.S.
universities. Absence of TOEFL scores could jeopardize your chance of obtaining a Fellowship. After passing a
preliminary English test, you must register for TOEFL immediately and take it as early as possible and no later than
November 2012. For information and/or test registration forms, contact the Binational Education/Fulbright Commission or
U.S. Embassy in your home country. You must indicate that you want your score reports sent to Institute of International
Education (Hubert H. Humphrey Fellowship Program) Code Number 9616. You must be sure to indicate this code (9616) on
the registration forms or on the answer sheets provided at the time you take the examination. TOEFL vouchers will be given
to finalists by the Binational Commission or U.S. Embassy.
As soon as you receive your TOEFL score, please present it to the Binational Commission or U.S. Embassy.
7. As part of your application, you also must have a formal English language interview and submit the enclosed English
Language Report Form (page 7 of the application).
2
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
Bio-Sheet A
1. NAME OF APPLICANT (Exactly as on your passport/ travel docuents! " #. $E%" Feale Male
Mr.
(Title)

(First name)

(Middle name)

(Last name)
&. PLACE OF 'I(T) (c*ty or to+n,
country!"
-. PE(MANENT A..(E$$ OF APPLICANT"

Telep/one nu0er (*nclude country 1 c*ty codes!" )oe"
2or3" Fax" Ea*l"
4. .ATE OF
'I(T)
Mont/ .ay 5ear

3
6. CO7NT(5 OF P(E$ENT
CITI8EN$)IP"
9. PO$TAL A..(E$$ OF APPLICANT (I: sae as a0ove, +r*te ;sae<!

=. CO7NT(5 OF P(E$ENT (E$I.ENCE"

>. IN.ICATE 5EA( 1 CO7NT(5 OF AN5
P(E?IO7$ F7L'(I@)T @(ANT$"

1A. E.7CATION" L*st all o!t-!e"o#$%&' educat*onal *nst*tut*ons attended, 0eB*nn*nB +*t/ t/e ost recent, *nclud*nB any *n
+/*c/ you are currently enrolled. Cop*es o: d*ploas, acade*c transcr*pts, cert*:*cates, and EnBl*s/ translat*ons s/ould 0e
attac/ed. (To add ore *n:orat*on, please add ro+s or copy ta0le onto an add*t*onal s/eet.!
Nae o: *nst*tut*on,
un*vers*ty or pro:ess*onal
sc/ool, and locat*on
MaCor :*eld(s! o: study .ates attended (ont/
and year!
Actual nae o: d*ploa
or deBree (do not
translate!
.ate rece*ved or
expected
Fro To
1.
-.
9.
#.
11. Nae your (o!t !i)#i*i"%#t pu0l*cat*ons//onors/a+ards/proCects/ot/er accopl*s/ents"

1-" @I?E A 50-WOR+ $7MMA(5 OF 5O7( P(OPO$E. PROGRAM PLAN (ore coplete plan to 0e outl*ned on paBe 9D 0e
sure t/*s suary captures t/e essence o: your proBra plan!.

19. C7((ENT OCC7PATION"
5our Co0 t*tle"
.ates o: eployent (ont/ 1 year!"
Nae and address o: your place o:
eployent"

1#. .escr*0e your current Co0 respons*0*l*t*es"

3
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
Bio-Sheet B
1&. Prev*ous pos*t*ons /eld (0eB*n +*t/ ost recent!"
Nae 1 address o: place o: eployent Eo0 T*tle
.ates o: Eployent
Fro (*n years! To
1.

-.

9.

#.

&.

14. Please *nd*cate your coputer pro:*c*ency and level o: s3*ll *n +ord process*nB, spreads/eets, electron*c a*l, etc. Please 0e
spec*:*c.
16. Please *nd*cate countr*es outs*de your o+n, *nclud*nB t/e 7n*ted $tates, *n +/*c/ you /ave l*ved, traveled, or stud*ed. Please
l*st dates (ont/s/years! and reasons :or eac/ v*s*t. Please attac/ an add*t*onal s/eet *: necessary.
(eason :or v*s*t Country v*s*ted
.ates o: v*s*t
Fro (o/yr! To ((o/yr!
1.

-.

9.

#.

&.

4.

1=. Persons to 0e not*:*ed *n case o: eerBency"
In /oe country" In t/e 7n*ted $tates"
Nae" Nae"
Address" Address"
Telep/one" Telep/one"
(elat*ons/*p (elat*ons/*p"
I cert*:y t/at all *n:orat*on B*ven *n t/*s appl*cat*on *s coplete and accurate to t/e 0est o: y 3no+ledBe. I
ac3no+ledBe t/at I /ave copletely read and understood t/e Information and Application Instructions and I aBree to
coply +*t/ all reBulat*ons descr*0ed t/ere. I aBree to a0*de 0y t/e Pol*c*es Bovern*nB t/e select*on o:
Ful0r*B/t/)up/rey Brantees, as esta0l*s/ed 0y t/e E. 2*ll*a Ful0r*B/t Fore*Bn $c/olars/*p 'oard (F$'! (coplete
pol*c*es ava*la0le at /ttp"//exc/anBes.state.Bov/educat*on/:ul0r*B/t/::s0/pol*c*es/-AA#/! +/*c/ supercede all ot/er
docuents relat*nB to y appl*cat*on :or a )up/rey Fello+s/*p. I also aBree to return to y /oe country upon t/e
exp*rat*on o: y proBra *n t/e 7n*ted $tates o: Aer*ca.
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4
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
P&o)&%( P,%#
Nae o: appl*cant" Country"
1-.
(1!Please descr*0e your aCor area o: *nterest and expla*n /o+ t/*s area addresses t/e spec*:*c developent needs o: your
country.

(-! .escr*0e t/e type o: )up/rey proBra you +ould l*3e to underta3e *n order to eet t/ese c/allenBes. Ind*cate t/e 3*nds o:
acade*c course +or3, *nterns/*p exper*ences, and/or pro:ess*onal tra*n*nB exper*ences you +ould l*3e to underta3e.

(9! .escr*0e /o+ t/e acHu*s*t*on o: ne+ 3no+ledBe and s3*lls +*ll ass*st you *n /elp*nB your country to ac/*eve *ts developent
Boals.

5
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
Pe&!o#%, St%te(e#t! A
Nae o: Appl*cant" Country"
2r*te a paraBrap/ ans+er*nB eac/ o: t/e :ollo+*nB t/ree Huest*ons. Please use o#,' t/e space prov*ded
20. Please descr*0e /o+ you /ave deonstrated a stronB co*tent to pu0l*c serv*ce *n your pro:ess*onal/personal l*:e.
(*.e. pro:ess*onal respons*0*l*t*es, coun*ty or c*v*c *nvolveent, etc.!

21. Please state your pro:ess*onal Boals :or t/e next :*ve years and *nd*cate /o+ t/e tra*n*nB rece*ved under t/e )up/rey
ProBra +*ll contr*0ute to your anaBer*al s3*lls, leaders/*p a0*l*ty, and co*tent to pu0l*c serv*ce.

6
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
Pe&!o#%, St%te(e#t! B
Nae o: Appl*cant" Country"
22. .escr*0e a pro0le or c/allenB*nB s*tuat*on t/at you /ave resolved 0y us*nB your *n*t*at*ve. 2/at +as t/e outcoeI Please
select t/*s exaple care:ully. It s/ould *llustrate soet/*nB t/at you +ant t/e rev*e+ panel to 3no+ a0out your pro0leJsolv*nB,
leaders/*p a0*l*t*es, or co*tent to pu0l*c serv*ce.

7
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
S/0!t%#"e A0/!e Fie,$ o* St/$'
NOTE1 THIS PAGE SHOUL+ BE FILLE+ OUT ONLY BY THOSE APPLICANTS WHOSE PROPOSE+ FIEL+ OF STU+Y IS
SUBSTANCE ABUSE
Please contact t/e 7.$. E0assy or t/e '*nat*onal Educat*onal Co*ss*on *n your country 0e:ore coplet*nB t/e :ollo+*nB" (5our
coents s/ould 0e cont*nued on a separate s/eet *: ore space *s needed.!
1. 'r*e:ly descr*0e +/at you 3no+ a0out current su0stance a0use pro0les *n your country.


-. 'r*e:ly descr*0e recent su0stance a0use researc/ proCect(s! *n +/*c/ you /ave 0een enBaBed, t/e extent o: your role *n t/ese
proCect(s!, and l*st any pu0l*cat*ons *n connect*on +*t/ researc/ +or3 t/at you /ave done.

9. 'r*e:ly descr*0e an area o: su0stance a0use researc/ t/at you +ould l*3e to pursue 0ased on t/e needs *n your country.

8
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
Pe&!o#%, I#*o&(%tio#
I. PERSONAL FINANCIAL INFORMATION (Indicate all funds in your local currency.)
1. 5our annual salary
Incoe per year :ro ot/er sources"
-. 2*ll your salary 0e cont*nued dur*nB your stay *n t/e 7.$.I 5es No
I: yes +/at percentaBeI
II. +EPEN+ENTS1 The H/0e&t H. H/(h&e' Fe,,o2!hi P&o)&%( $oe! #ot &o3i$e %,,o2%#"e! *o& $ee#$e#t!. I: your
dependents accopany you, you +*ll 0e respons*0le :or prov*d*nB all travel, adeHuate ed*cal *nsurance, and support :or t/e.
E#),i!h4O&ie#t%tio# Ce#te&! "%##ot %""o((o$%te $ee#$e#t!. .ependents ay not arr*ve unt*l you are settled *n your
acade*c proBra and /ave :ound /ous*nB (at least 9A days a:ter your arr*val at acade*c placeent!.
1. Mar*tal status
-. L*st t/e relat*ons/*ps and aBes o: any persons +/o +*ll reHu*re :*nanc*al ass*stance :ro you dur*nB your acade*c year *n t/e
7.$."
1. 9.
-. #.
9. 2*ll any dependents accopany you to t/e 7.$.I 5es No
I: yes, B*ve nae(s! as s/o+n on passport(s!, Bender, relat*ons/*p(s!, date(s! o: 0*rt/, c*ty/country o: 0*rt/ and c*t*Kens/*p :or eac/
dependent. Please also state /o+ you *ntend to prov*de :or t/e dur*nB your year o: study *n t/e 7.$.

III. ACA+EMIC PROGRAM
1. I: reHu*red, +*ll you 0e a0le to arr*ve :or EnBl*s/ lanBuaBe
tra*n*nB as early as Apr*l, May, Eune or EulyI
5es No
-. 2*ll you 0e a0le to o0ta*n a leave o: a0sence :ro your
current pos*t*on :or a per*od o: 11 ont/s, or up to 1# ont/s *:
you reHu*re EnBl*s/ tra*n*nBI
5es No
9. 2/en +*ll you ta3e a standard*Ked test t/at assessed your
EnBl*s/ lanBuaBe a0*l*ty, suc/ as TOEFLI

I: you /ave not sc/eduled t/*s test 0e:ore Nove0er 1, -A11, you ust not*:y t/e '*nat*onal Educat*onal Co*ss*on or 7.$.
E0assy *n your /oe country i((e$i%te,'.
IMPORTANT
1. An official TOEFL score (no more than two years old) is required for all countries ecept the En!lish spea"in! #ari$$ean.
%. &ou must indicate that you want your TOEFL score reports sent to' Institute of International Education ((u$ert (umphrey
Fellowship )ro!ram) #ode *um$er 9616. &ou must $e sure to indicate this code (+,1,) on the re!istration forms or on
the answer sheets pro-ided at the time you ta"e the eamination.
.. As soon as you recei-e your TOEFL score/ report it to the 0inational Educational #ommission or 1.2. Em$assy.
3. )lease si!n $elow as authori4ation for IIE to recei-e your TOEFL score.
I /ere0y aut/or*Ke t/e Inst*tute o: Internat*onal Educat*on to rece*ve y TOEFL score report.
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9
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
Co#*i$e#ti%, ,ette& o* &e*e&e#"e *&o( "/&&e#t e(,o'e&
Thi! ,ette& o* &e*e&e#"e (/!t 0e 2&itte# 0' the %,i"%#t5! "/&&e#t !/e&3i!o& i# hi!4he& &o*e!!io#%, o!itio#.
I: t/*s letter *s not +r*tten *n EnBl*s/, an accurate translat*on ust 0e attac/ed
N%(e o* A,i"%#t1
Co/#t&'1
N%(e %#$ Tit,e o* E3%,/%to&1
O&)%#i6%tio# o& E(,o'e&1
Ho2 ,o#) h%3e 'o/ 7#o2# the %,i"%#t8
Si)#%t/&e (*n *n3!1 +%te1
PROGRAM +ESCRIPTION
T/e )up/rey Fello+s/*p ProBra prov*des *dJcareer pro:ess*onals :ro des*Bnated countr*es o: A:r*ca, As*a, Lat*n Aer*ca,
t/e Car*00ean, t/e M*ddle East, and Euras*a +*t/ an opportun*ty to en/ance t/e*r pro:ess*onal capa0*l*t*es t/rouB/ part*c*pat*on *n
spec*al*Ked 1AJont/ proBras developed spec*:*cally :or sall clusters o: )up/rey Fello+s at selected 7.$. un*vers*t*es.
Pr*ary :und*nB :or t/e )up/rey ProBra *s prov*ded 0y t/e 7.$. Bovernent t/rouB/ t/e 7n*ted $tates .epartent o: $tate.
T/e Inst*tute o: Internat*onal Educat*on (IIE! ad*n*sters t/e proBra on 0e/al: o: t/e $tate .epartent.
T/e types o: un*vers*ty proBras arranBed :or )up/rey Fello+s depart :ro a trad*t*onal d*sc*pl*neJor*ented :ocus and /ave a
pro0leJsolv*nB and exper*enceJs/ar*nB ep/as*s. T/e proBras are not deBreeJrelated and not a*ed at prov*d*nB sc/olarly
preparat*on or 0as*c tra*n*nB *n a :*eld. T/e o0Cect*ve *s to prov*de )up/rey Fello+s +*t/ an overall exper*ence t/at 0roadens t/e*r
perspect*ves, en/ances t/e*r capa0*l*ty to assue Breater career respons*0*l*t*es, and prov*des opportun*t*es to esta0l*s/ use:ul
pro:ess*onal contacts. To accopl*s/ t/ese o0Cect*ves, proBras are des*Bned to *nclude var*ous co0*nat*ons o: course +or3,
*ndependent proCects, *nterns/*ps, consultat*ons +*t/ 7.$. :aculty or experts, :*eld tr*ps, and se*nars. 7nder t/e Bu*dance o: a
des*Bnated :aculty adv*sor or Lcoord*nator,L Fello+s plan proBras t/at 0est su*t t/e*r *nd*v*dual career developent needs.
I. In t/e rat*nB c/art 0elo+, please evaluate t/e appl*cant *n copar*son +*t/ ot/er pro:ess*onals +/o you /ave 3no+n dur*nB
your career.
E9"e,,e#t :e&' Goo$ A3e&%)e Be,o2 A3e&%)e
Intellectual A0*l*ty
Gno+ledBe o: F*eld
2or3 )a0*ts
$er*ousness o: Purpose
Co*tent to Nat*onal .evelopent
(esource:ulness and In*t*at*ve
Eot*onal Matur*ty
Adapta0*l*ty to Ne+ $*tuat*ons
Leaders/*p Mual*t*es
10
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
Co#*i$e#ti%, ,ette& o* &e*e&e#"e *&o( "/&&e#t e(,o'e& ;"o#t.<
II. Please assess t/e cand*dateNs su*ta0*l*ty :or t/e )u0ert ). )up/rey Fello+s/*p ProBra 0ased on /*s//er educat*onal
0ac3Bround, +or3 exper*ence and *nd*v*dual needs :or career developent. (A descr*pt*on o: t/e )up/rey ProBra *s on t/e
:ront o: t/*s paBe.! Include a cand*d evaluat*on o: t/e appl*cantNs a0*l*ty to pursue ser*ous acade*c +or3 *n t/e context o: a *dJ
career pro:ess*onal proBra. Ind*cate also /o+ t/*s proBra +*ll d*rectly 0ene:*t not only t/e cand*dateNs career 0ut /*s//er country
and soc*ety. Also d*scuss t/e cand*dateNs leaders/*p potent*al and co*tent to pu0l*c serv*ce.
(5our coents s/ould 0e cont*nued on a separate s/eet *: ore space *s needed.!

P,e%!e &et/&# $i&e"t,' to the Se,e"tio# Co((ittee i# the %,i"%#t5! "o/#t&' o& to the C/,t/&%, A**%i&! O**i"e& o* the U.S.
$i,o(%ti" (i!!io# i# the %,i"%#t5! "o/#t&'. U#$e& #o "i&"/(!t%#"e! !ho/,$ thi! ,ette& o* &e*e&e#"e 0e &et/&#e$ to the
%,i"%#t.
NOTE1 IIE "%##ot )/%&%#tee thi! ,ette&5! "o#*i$e#ti%,it' o#"e it 0e"o(e! %&t o* % /#i3e&!it'5! &e"o&$!.
11
HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
Co#*i$e#ti%, ,ette& o* &e*e&e#"e
Thi! ,ette& o* &e*e&e#"e (/!t 0e 2&itte# 0' % &o*e!!o&= &o*e!!io#%, (e#to&= o& othe& %!!o"i%te o/t!i$e the "%#$i$%te5!
"/&&e#t 2o&7 !etti#). Pe&!o#%, *&ie#$! o& *%(i,' (e(0e&! %&e NOT %""et%0,e &e*e&e#"e!. I: t/*s letter *s not +r*tten *n
EnBl*s/, an accurate translat*on ust 0e attac/ed.
N%(e o* A,i"%#t1
Co/#t&'1
N%(e %#$ Tit,e o* E3%,/%to&1
O&)%#i6%tio# o& E(,o'e&1
Ho2 ,o#) h%3e 'o/ 7#o2# the %,i"%#t8
I# 2h%t "%%"it' h%3e 'o/ 7#o2# the
%,i"%#t8
Te%"he& o& P&o*e!!o&1
Othe& ;P,e%!e !e"i*'<1
Si)#%t/&e (*n *n3!1 +%te1
PROGRAM +ESCRIPTION
T/e )up/rey Fello+s/*p ProBra prov*des *dJcareer pro:ess*onals :ro des*Bnated countr*es o: A:r*ca, As*a, Lat*n Aer*ca,
t/e Car*00ean, t/e M*ddle East, and Euras*a +*t/ an opportun*ty to en/ance t/e*r pro:ess*onal capa0*l*t*es t/rouB/ part*c*pat*on *n
spec*al*Ked 1AJont/ proBras developed spec*:*cally :or sall clusters o: )up/rey Fello+s at selected 7.$. un*vers*t*es.
Pr*ary :und*nB :or t/e )up/rey ProBra *s prov*ded 0y t/e 7.$. Bovernent t/rouB/ t/e 7n*ted $tates .epartent o: $tate.
T/e Inst*tute o: Internat*onal Educat*on (IIE! ad*n*sters t/e proBra on 0e/al: o: t/e $tate .epartent.
T/e types o: un*vers*ty proBras arranBed :or )up/rey Fello+s depart :ro a trad*t*onal d*sc*pl*neJor*ented :ocus and /ave a
pro0leJsolv*nB and exper*enceJs/ar*nB ep/as*s. T/e proBras are not deBreeJrelated and not a*ed at prov*d*nB sc/olarly
preparat*on or 0as*c tra*n*nB *n a :*eld. T/e o0Cect*ve *s to prov*de )up/rey Fello+s +*t/ an overall exper*ence t/at 0roadens t/e*r
perspect*ves, en/ances t/e*r capa0*l*ty to assue Breater career respons*0*l*t*es, and prov*des opportun*t*es to esta0l*s/ use:ul
pro:ess*onal contacts. To accopl*s/ t/ese o0Cect*ves, proBras are des*Bned to *nclude var*ous co0*nat*ons o: course +or3,
*ndependent proCects, *nterns/*ps, consultat*ons +*t/ 7.$. :aculty or experts, :*eld tr*ps, and se*nars. 7nder t/e Bu*dance o: a
des*Bnated :aculty adv*sor or Lcoord*nator,L Fello+s plan proBras t/at 0est su*t t/e*r *nd*v*dual career developent needs.
I. In t/e rat*nB c/art 0elo+, please evaluate t/e appl*cant *n copar*son +*t/ ot/er pro:ess*onals +/o you /ave 3no+n dur*nB
your career.
E9"e,,e#t :e&' Goo$ A3e&%)e Be,o2 A3e&%)e
Intellectual A0*l*ty
Gno+ledBe o: F*eld
2or3 )a0*ts
$er*ousness o: Purpose
Co*tent to Nat*onal .evelopent
(esource:ulness and In*t*at*ve
Eot*onal Matur*ty
Adapta0*l*ty to Ne+ $*tuat*ons
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HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
Leaders/*p Mual*t*es
Co#*i$e#ti%, ,ette& o* &e*e&e#"e ;"o#t.<
II. Please assess t/e cand*dateNs su*ta0*l*ty :or t/e )u0ert ). )up/rey Fello+s/*p ProBra 0ased on /*s//er educat*onal
0ac3Bround, +or3 exper*ence and *nd*v*dual needs :or career developent. (A descr*pt*on o: t/e )up/rey ProBra *s on t/e
:ront o: t/*s paBe.! Include a cand*d evaluat*on o: t/e appl*cantNs a0*l*ty to pursue ser*ous acade*c +or3 *n t/e context o: a *dJ
career pro:ess*onal proBra. Ind*cate also /o+ t/*s proBra +*ll d*rectly 0ene:*t not only t/e cand*dateNs career 0ut /*s//er country
and soc*ety. Also d*scuss t/e cand*dateNs leaders/*p potent*al and co*tent to pu0l*c serv*ce.
(5our coents s/ould 0e cont*nued on a separate s/eet *: ore space *s needed.!

P,e%!e &et/&# $i&e"t,' to the Se,e"tio# Co((ittee i# the %,i"%#t5! "o/#t&' o& to the C/,t/&%, A**%i&! O**i"e& o* the U.S.
$i,o(%ti" (i!!io# i# the %,i"%#t5! "o/#t&'. U#$e& #o "i&"/(!t%#"e! !ho/,$ thi! ,ette& o* &e*e&e#"e 0e &et/&#e$ to the
%,i"%#t.
NOTE1 IIE "%##ot )/%&%#tee thi! ,ette&5! "o#*i$e#ti%,it' o#"e it 0e"o(e! %&t o* % /#i3e&!it'5! &e"o&$!.
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HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2015-2016
A,i"%#t Che"7,i!t
PLEA$E $A?E T)I$ FO(M AN. (EFE( TO IT
IN $7'MITTIN@ 5O7( APPLICATIONO
APPLICANT CHEC>LIST
FOR SUBMISSION OF APPLICATION
Copleted Appl*cat*on (Fors 1J-J9J#J&J4!

O::*c*al transcr*pts and d*ploas +*t/ translat*ons *: necessary

1st Letter o: (e:erence (Fors = and =A!

$u0stance A0use F*eld o: $tudy :or *: appl*ca0le (For &A!

.ate o: TOEFL exa

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