2015 -2016 FULBRIGHT STUDENT FELLOWSHIPS

APPLICATION FORM
1. FULL NAME: ________________________________________________________________________

2. YEAR AND PLACE OF BIRTH: ________________________________________________________

3. CONTACT ADDRESS / Telephone & E-mail:______________________________________________

4. PRESENT POSITION:
TITLE: ____________________________________________________________________________________________
INSTITUTION: ______________________________________________________________________________________

5. PREVIOUS POSITIONS / Include dates held:

TITLE / DATES: _____________________________________________________________________________________
INSTITUTION: _____________________________________________________________________________________
TITLE / DATES: _____________________________________________________________________________________
INSTITUTION: ______________________________________________________________________________________

6. EDUCATION: / If necessary, you may continue this section on a separate sheet of paper. Please attach to your application certified copy of your
BA diploma with transcripts /

A.

DEGREE RECEIVED: ________________________________________________________________________________

YEAR: _____________________________________________________________________________________________
INSTITUTION: ______________________________________________________________________________________

B.

DEGREE RECEIVED: ________________________________________________________________________________

YEAR: _____________________________________________________________________________________________
INSTITUTION: ______________________________________________________________________________________

C.

DEGREE RECEIVED: ________________________________________________________________________________

YEAR: _____________________________________________________________________________________________
INSTITUTION: ______________________________________________________________________________________
(CONTINUE ON NEXT PAGE)
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7. ENGLISH LANGUAGE ABILITY / Please indicate what you think your skill level is in each of the following areas:
READING:

Fluent

Good

Fair

Minimal

SPEAKING:

Fluent

Good

Fair

Minimal

LISTENING:

Fluent

Good

Fair

Minimal

Please provide a valid copy of your TOEFL score sheet

8. IF YOU WERE SELECTED FOR A FULBRIGHT STUDENT FELLOWSHIP, WHAT KIND OF PROGRAM WOULD
YOU WISH TO ENROLL IN? WHAT FIELD WOULD YOU STUDY?
MA

M.S.

Field: _____________________________________________________________________________________________________
__________________________________________________________________________________________________________
9. IS THERE A SPECIFIC UNIVERSITY OR PROGRAM YOU ARE INTERESTED IN? IF SO, PLEASE GIVE THE
NAME OF THE SCHOOL AND THAT OF THE DEPARTMENT OR PROGRAM:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
10. PLEASE INDICATE ANY PREVIOUS TRAVEL TO THE UNITED STATES:
Purpose: __________________________________________________________________________________________________
When: ____________________________________________________________________________________________

11. REFERENCES: Please attach letters of recommendation from two people who can attest to your academic and
professional abilities. (Recommendation letters in English only or please provide the official translation of the
Mongolian letter. Notarized copies of original letters are acceptable).
12. ESSAY: Please attach a concise (no more than two pages long) essay, in English, which explains why you wish to
study in the United States, and what you would like to do after completing that study.
13. EDUCATION: Please attach a certified copy of your university diploma
- Certified copies of original documents will be acceptable. Please note that any part of submitted application
package will not be returned to applicant
- Please do not staple any part of your application and affiliated supplemental documents. Use paper clips if needed
-Please do not submit any other additional documents except asked in this application
Interviews will take place late May or early June, 2014. Applicants must be present for the interview.

Completed applications must be returned to Public Affairs Section by 12 noon on April 11, 2014:

Big Ring Road, XI Microdistrict

Entry House, U.S. Embassy
Ulaanbaatar
Telephone: 7007-6001 ext. 6182 or 6296