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Humphrey Applicationform

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15 views

Humphrey Applicationform

Uploaded by

laurensandoval0
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 4

Hubert H.

Humphrey Fellowship
Preliminary Application Form

In order to process your preliminary application, include copy of transcripts and diplomas; copy of standardized English test
score report, copy of Honduran ID, Program Plan and Personal Statement.
DEADLINE: July 31 Inquiries: [email protected] Information: www.humphreyfellowship.org

Personal Information
As it appears in ID card or passport

Last name(s)

First name

Middle name

Honduran ID number

Passport number (if available)

Date of birth (Month/Day/Year)

Place of Birth (city, department, state of province and country

Contact Information

e-mail

Cellular

Home phone Office phone

Address

Study Plan

Proposed Field of Study


In English, give a 50-word summary of your proposed program plan

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Education
List all post-secondary educational institutions attended, beginning with the most recent, including any in which you are currently enrolled.
Please attach an additional sheet if needed. Submit copies of academic transcripts and diplomas.

Name of institution
Dates attended From To
Location
Name of degree
Date of degree (received or expected to receive)
Name of institution
Dates attended From To
Location
Name of degree
Date of degree (received or expected to receive)

Name of institution
Dates attended From To
Location
Name of degree
Date of degree (received or expected to receive)

Name of institution
Dates attended From To
Location
Name of degree
Date of degree (received or expected to receive)

Accomplishements
Name your most significant publications, honors, awards, projects or other accomplishments. Attach a separate sheet if necessary.

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Current Occupation
Organization
Job Title
Dates of Employment (month/year) From to

Address

Describe your current job responsibilities:

Previous Positions
Begin with most recent.
Dates of Employment
Name and Address of Place of Employment Job Title (From and To - in years)

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Standardized English Test Score
Please submit a copy of a Standardized English Test score report (TOEFL, TOEIC, IELTS or other)
Test taken
Date taken
Score

Travel Abroad
Please indicate foreign countries, including the United States, in which you have lived, traveled, or studied. Please list dates (months / years) and
reasons for each visit. Please attach an additional sheet if needed.

Country Visited Reason for Visit (study, work, tourism, coference,etc.) Dates of Visit
From (mon/yr) To (mon/yr)

Program Plan
In English and on a separate sheet, please describe:
1) Your major area of interest and explain how this area addresses specific development needs in Honduras;
2) The type of Humphrey program you would like to design. Indicate the kinds of academic and professional experiences you
would like to pursue;
3) How the knowledge and skills you will gain will help you address development needs in Honduras.

Personal Statement
In English and on a separate sheet :
1) Please describe how you have demostrated a strong commitment to public services (i.e. community, civic involvement or
professional responsibilities, etc.)
2) Please state your professional goals for the next five years. How will the Humphrey Program help you reach them?

APPLICATION DEADLINE: JULY 31


Options for delivery of application and supporting documents
E-mail [email protected]
Please submit as a single PDF document that includes scans of the filled out application form, Program Plan, Personal Statement, transcripts, diplomas, Honduran
ID and standardized English test score report. Please name the file like this: "HHH pre-app NAME" (ex: HHH pre-app John Doe.pdf)

Can be delivered by mail, courrier or hand-delivered to Portón 3 (back of Embassy building). All hard copies should be placed in
Hard copies a sealed envelope addressed to:
Hubert H. Humphrey Program
Public Affairs Section
U.S. Embassy
Avenida La Paz
Tegucigalpa, M.D.C., Honduras

Inquiries: [email protected] Information: www.humphreyfellowship.org

Page 4 of 4

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