2023-2024 Fulbright Graduate Scholarship

To be completed by the applicant:

NAME
Last First Middle Title (Mr., Miss, Mrs., Prof., Dr.)

Mobile Number _____________________

Email address: ______________________

CPR Number _______________________

Birth date: __________________________

Month/Day/Year

Country of citizenship:

Place of birth:

I wish to apply for the Fulbright Graduate Scholarship

Major field of Study you want to pursue _____________________________

Specialization ___________________________________

-1-
 FULBRIGHT CHECKLIST

Applicant’s Name: _______________________________________________________________________

Your application and all documents must be typed, completed, scanned as one PDF file and
emailed to [email protected] as one attachment.

Application and documents should be emailed to [email protected] not later

than August 16, 2022.

Documents to include:
This Application
High School Degree: 
Copy of Transcript of Grade 12 in original language

Bachelor’s Degree: 
Copy of Undergraduate transcript in original language
 Copy of Undergraduate diplomat/certificate in original language
 Copy of Undergraduate transcript in English only if available
 Copy of Undergraduate diplomat/certificate in English only if available
 Master’s degree (IF AVAILABLE):
Copy of Graduate transcript (if applicable) in original language
 Copy of Graduate diplomat/certificate (if applicable) in original language

 Copy of Graduate transcript (if applicable) in English

 Copy of Graduate diplomat/certificate (if applicable) in English

Copy of three recommendation letters

Copy of Passport
 Copy of Smart card
Copy of CV

Copy of TOEFL or IELTS score (valid or expired) only if available

Attached one Passport size photo

-2-
 Fulbright
Application Summary Sheet

To be completed by the applicant:

NAME
Last First Middle Title (Mr., Miss, Mrs., Prof., Dr.)

PERSONAL DATA:
Sex: Male Female Birthdate: __________________ Place:
Month/Day/Year City Country

Country of permanent legal residence: Country of citizenship:

Do you also hold U.S. citizenship? Yes No
Do you also have U.S. permanent residency (a green card) ? Yes No
Current Address:
Current Occupation: Since:
Employer/Affiliation:

EDUCATIONAL DATA (begin with most recently attended and any in which currently enrolled):
Institution/Country Dates Field of Study Degree/diploma Date received/expected

Most significant awards/honors/publications/other accomplishments:

Previous Fulbright grants or U.S. government exchange program (program name, year, country, duration,
visa type):

Proposed field of study, description of specific area of interest and future plans upon return to home country
(do not attach additional sheet):

To be completed by Fulbright Foreign Scholarship Board Member:

Approve Disapprove Abstain
Comments:
Name (print): Signature: Date:

-3-
 FULBRIGHT
APPLICATION COVER SHEET
This form must be included with your completed application.

YOUR NAME
(as it appears on your passport) Last First Middle Title (Mr., Miss,
Mrs., Prof., Dr.)

HOME COUNTRY CONTACT INFORMATION

Permanent mailing address in your home country: Mobile #: ___________________

Home #:

Office #:

Fax #:

E-mail address:

HOW DID YOU FIND OUT ABOUT THE PROGRAM? Please check all that apply.

At your local AMIDEAST office (Please specify how—through a display, advising session, etc.):

From a former Fulbright grantee From a friend From a relative From a teacher or professor

From an advertisement (Please specify the location of the ad):

Other (Please specify how):

PERSONAL INFORMATION

Marital status: Single Engaged Married Spouse’s full name:

Spouse’s citizenship: ________________________________________ Number of children:

Number of dependents to accompany/join you in United States:

EMERGENCY CONTACT INFORMATION

Please provide the names and contact information of individuals who should be notified in case of an emergency.

In the United States:

Name Relationship to you Street Address

City State ZIP Code Telephone Number E-mail address

In your home country:

Name Relationship to you Street Address

City State and/or Country Telephone Number E-mail address

Does the contact in your home country speak English? Yes No

If the contact does not speak English, please indicate any language other than Arabic that he/she speaks:

-4-
 FULBRIGHT
APPLICATION FOR STUDY IN THE UNITED STATES
The Fulbright Program is sponsored by the United States Department of State Bureau of Educational and Cultural Affairs (ECA)
AMIDEAST administers the Fulbright Foreign Student Program for ECA

YOUR NAME
(as it appears on your passport) Last First Middle Title (Mr., Miss,
Mrs., Prof., Dr.)

Please indicate any other spelling(s) or name(s) you use:

(Affix photo here)

FIELD OF STUDY

Major Field of Study:

Area of Specialization:
Degree Objective:
Master's

PERSONAL DATA

Sex: Male Female Date of Birth: Place:

Month/Day/Year City Country

Country of permanent legal residence: __________________________ Country of citizenship:

Current academic/professional status (student status or job title):

REFERENCES

Please identify the three (3) individuals who will be writing letters of recommendation on your behalf.

1. Name: Title:

Mailing address:

Telephone number: E-mail address:

2. Name: Title:

Mailing address:

Telephone number: E-mail address:

3. Name: Title: _________________________________

Mailing Address:_________ ______________________________________________________________

Telephone number: E-mail address:

-5-
 Name:

PREVIOUS ACADEMIC HONORS

Please indicate any fellowships, scholarships, academic awards, or honors that you have received. If you have
produced any publications, please also list them here.

EDUCATIONAL BACKGROUND

Please provide complete information about all the educational institutions that you have attended and, if applicable,
information about the institution(s) at which you are presently enrolled.

Institution Name Institution Dates Attended Major Field Degree Grade Point
(No abbreviations) Location MM/YY – of Study Received and Average (out
(City, MM/YY Date Received of 100% or
Country) GPA 4.00)
Intermediate School: From: To:

High School/Thanaweya: From: To:

University “bachelor degree” From: To:

University “Master degree” If From: To:

Available

-6-
Name:

* Please identify the name of your degree by the word used at the institution that awarded you the degree. Do not
provide the name of the U.S. educational system’s equivalent. If you have not yet received the degree, please
indicate the date (month and year) you expect to receive it.

** Please indicate your Grade Point Average (GPA) according to the system used at the institution at which you
studied. Do not convert your GPA to the U.S. educational system’s equivalent.

Please explain any gaps in your education:

Have you ever been dismissed from a university? No Yes If yes, please explain why:

LANGUAGE PROFICIENCY

Native language(s):

Number of years of English study: _____________________ Where studied:

Knowledge of foreign languages, including English (Rate your abilities as Excellent, Good, or Fair):

Language Name Reading Ability Writing Ability Speaking Ability

English

STANDARDIZED TEST SCORES

Please indicate your TOEFL, GRE, and/or GMAT scores. For the GRE General Test, please specify your Verbal
(V), Quantitative (Q), and Analytical (A) scores. ONLY IF AVAILABLE

Test Name Date taken or to be taken Score

GRE (V) (Q) (A)
GRE SUBJECT
TOEFL
GMAT
OTHER

-7-
Name:

EMPLOYMENT EXPERIENCE

Please start with your most recent position. You may also attach a resume or curriculum vitae (CV).

Name of Employer and Your Job Title and Responsibilities Dates of Employment
Employer’s Mailing Address MM/YY – MM/YY
From: To:

From: To:

From: To:

From: To:

From: To:

NON-ACADEMIC ACTIVITIES Please list all volunteer positions, work experience, awards, and leadership positions
you have held within the past four years. If you were a team leader, council member or other officer in any institution or
activity, please note that as well.

Location/Institution and Contact Type of Activity Dates of Participation

MM/YY – MM/YY
From: To:

From: To:

From: To:

From: To:

Physical Impairment
Please describe any physical impairment you might have. If you require any special equipment or medical treatment
as a result of the physical impairment, please describe it. This information is gathered for statistical purposes and to
ensure appropriate placement. The Fulbright Program does not discriminate on the basis of race, color, religion, sex,
national origin, and/or physical impairment.

-8-
Name:

ESSAYS: Future Plans and Statement of Purpose

If you are completing a computer application, please insert your essay responses below the appropriate essay
question. If you are completing a paper application, please type your essay responses on separate sheets of paper
and attach them to your completed application.

Future Plans

Please describe the career you plan to pursue after completion of study or research in the United States. Indicate if
you will return to your former job, or if you have been selected to fill new position in your home country upon
completion of your academic program in the United States. Please explain any plans you may have for continued
research in your home country. (Maximum 1 page)

Statement of Purpose

Please write a clear and detailed description of your academic objectives and the reasons why you wish to pursue
them. Discuss your goals both in terms of your field of study in general and within your specific area of
specialization. Describe the type of program you wish to pursue and how it relates to your academic and
professional background and your objectives for the future. Please keep in mind that the essay will be an essential
part of your application for placement into an appropriate program. In your essay do not name specific universities
at which you would like to study. (Maximum 1 page)

GRANT SUSPENSION/TERMINATION/REVOCATION

A grant may be revoked, terminated, or suspended.

Grounds for revocation or termination include, but are not limited to: (1) violation of any law of the United States or the host
country; (2) any act likely to give offense to the host country; (3) failure to observe satisfactory academic or professional
standards; (4) physical or mental incapacitation; (5) engaging in any unauthorized income-producing activity; (6) failure to
comply with the grant’s terms and conditions; (7) material misrepresentation made by any grantee in the application form or
grant document.

A grant may be suspended if: (1) the grantee ceases to carry out the project or academic program during the grant period; (2)
the grantee leaves the host country without authorization of the Commission/post or supervising agency; (3) conditions in the
host country require the departure of the grantee for reasons of personal safety or security.

SIGNATURE

By my signature, I certify that, to the best of my knowledge, the information provided in my application is accurate
and complete, and that I intend to return to my home country upon completion of my studies in the United States. I
have asked AMIDEAST to arrange for my placement at an American university and request that all correspondence
be directed to AMIDEAST at the address on the first page of this application. I also authorize any school or
university which I have attended or will attend to release my transcripts and any report to AMIDEAST.

Signature: Date:

-9-