U I E L S P Pplication ORM: Ndergraduate Ntensive Nglish Anguage Tudy Rogram

A program of the Bureau of Educational and Cultural Affairs, U.S.
Department of State
UNDERGRADUATE INTENSIVE ENGLISH LANGUAGE STUDY PROGRAM
2011 APPLICATION FORM
Directions:
All answers must be submitted in English. Please submit all pages electronically by Monday, December 20, 2010.
NAME
Please make sure that this information matches exactly how it appears on your passport.
Last name: TUAN ANH First name: QUACH Middle name: HUU
Indicate any other spelling(s) or name(s) you use:
U.S. PROGRAM DATES:

Participants will be placed in one of three programs at U.S. institutions that take place on dates indicated below. Please provide the
preferences for your program dates by ranking them in the chart below in the RANK column. If you cannot travel to the U.S. for one or
more of program dates, please mark the box under CANNOT ATTEND with an X. An attempt to place nominees in Programs of their
choice will be made by the State Department, but your preferences cannot be guaranteed. Candidates who provide more options may
have a greater chance of participation.
EXAMPLE: If your first choice of program is Program 2, your second Applicant Preferences:
choice is Program 1, and you are unable to attend Program 3, your
selection would be:
PROGRAM NUMBER: Dates RANK CANNOT PROGRAM NUMBER: Dates RANK CANNOT
ATTEND ATTEND
Program 1: June 6-August 1, 2011 2 Program 1: June 6-August 1, 2011 1
Program 2: June 11-August 6, 2011 1 Program 2: June 11-August 6, 2011 2
Program 3: June 21-August 20, 2011 Program 3: June 21-August 20, 2011 3
HOME COUNTRY CONTACT INFORMATION

Permanent mailing address in your home country:
Street address: K01B/38 LeTrong Tan
City, state, postal code: Da Nang,Viet Nam
Additional contact information:

E-mail address: tuananhqh@gmail.com
Home telephone: 0511 3722496
Mobile telephone: 0905 910638
Fax number:
PERSONAL DATA AND PASSPORT INFORMATION
Sex: Male Female
Date of birth: 12 (month) / 11(day) /1989(year)
Place of birth:Ha Tinh(city),Da Nang(country)
Country of permanent legal residence: Viet Nam
Country of citizenship: ________________
This program requires that a clear copy of your passport be submitted with your application. Copy submitted:
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A program of the Bureau of Educational and Cultural Affairs, U.S. Department of State
NAME: QUACH HUU TUAN ANH COUNTRY: VIET NAM
ACADEMIC INFORMATION
University you attend: DA NANG UNIVERSITY OF TECHNOLOGY
Highest level of coursework you will have completed by January 1, 2011 (please check one below):
1st year undergraduate study 2nd year undergraduate study 3rd year undergraduate study Other (explain: 4rd year
undergraduate study )
Major field of study/interest: Embedded System
Minor field of study/interest: Philosophy
Indicate any scholarships, academic awards or honors that you have received and the year awarded:
Award: Certificate of Merit of Royal Australian Chemical Institute Year: 2003
Award: annual scholarship of university Year: 2007-2008,2008-2009,2009-2010
Award: Studios scholarship of the local Year: 2008
Award: Studios scholarship of the local Year: 2009
EDUCATIONAL BACKGROUND
Please 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. See Application Instructions for information regarding documentation you must
provide pertaining to your completed studies.
Institution Name Location Dates Attended Major Field Degree and Date Grade Point
(No abbreviations) (City, Country) MM/YY – MM/YY of Study Received* Average**
Primary School: Nguyen Da Nang,Viet Nam From: To: Excellent 9.0
Binh Khiem 1993 1998 5/1998
Secondary School:Nguyen Da Nang,Viet Nam From: To: Good 8.5

Dinh Chieu 1998 2003 5/2003
Post-Secondary Education: Da Nang,Viet Nam From: To: Electronic and Good 8.3
(University) Da Nang 2007 2012 Telecommunication 6/2010
University of technology
* Identify the name of your degree by the word used at the institution that will award/awarded the degree. If you have not yet received
the degree, please indicate the date (month and year) you expect to receive it.
** 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.
Explain any gaps in your education: There are 2 gaps in major field of study because in our country, in primary school and secondary
school, we have to learn general education which includes many subjects.
Have you ever been dismissed from a school or university? No Yes
If yes, please explain: ___________________________________________________________________
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LANGUAGE PROFICIENCY
Native language(s): VIET NAM
Number of years of English study: 15 Where studied: School and university.
Rate your knowledge of all non-native languages, including English, as Excellent, Good, or Fair:
Language Name Reading Ability Writing Ability Speaking Ability

English Excellent Good Good
French Good Fair Fair
STANDARDIZED ENGLISH TEST SCORES

Indicate your most recent TOEFL®, ITP TOEFL®, or other standardized test scores.
Test Name Date Score

TOEFL®
ITP TOEFL®
OTHER (Name:IELTS) 12/JUL/2008 6.5
OTHER ACTIVITIES
List other community service, internships/jobs, sports or cultural activities in which you have participated regularly in the past two
years. If you were a team leader, council member or other officer in any institution or activity, please note that as well.
Dates of Participation
Institution, Location, and Contact Type of Activity
MM/YY – MM/YY
Project UOMMAM. This is a volunteer Volunteer services. From: To:
project that is organized by co- 2008 2010
operating between DaNang university
Technology and Singapore
Management University.
Contact : Red Cross Humanitarian

Network.
English club in Da Nang city. I am one We exchange knowledge to help each others in From: To:
of the leaders in English group. improving English skill and social interaction. 2007 2010
I am the member of football club in my Sport From: To:

university. 2007 2010
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EMERGENCY CONTACT INFORMATION

Provide the names and contact information of individuals who should be notified in case of an emergency.
Emergency contact in your home country: Emergency contact in the United States:
Full name: QUACH HUU DINH Full name: __________________
Relationship to you: My Father Relationship to you: __________________
Street address: K01B/38 Le Trong Tan Street address: __________________
City, state, postal code: Da Nang,Viet Nam City, state, postal code: __________________
E-mail address: __________________ E-mail address: __________________
Home telephone: 0511 3722496 Home telephone: __________________
Mobile telephone: 0905 91038 Mobile telephone: __________________
PREVIOUS EXPERIENCE IN THE UNITED STATES

Do you have family currently living in or studying in the United States? No Yes (if yes, please list)
Name (list family Relationship Current address Date arrived in the United Occupation (profession,
members in same box) (to you) (city, state) States (month, year) student, other-explain)
Have you traveled to the United States before? No Yes (if yes, please list)
Place traveled to (city, state) Dates traveled (month, year) Reason for travel
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BACKGROUND
Physical Challenges/Disabilities or Medical Conditions
Describe any physical disabilities you might have. If you require any special equipment or medical treatment as a result of the physical
disabilities, please describe it. This information is gathered for statistical purposes and to ensure appropriate placement. The program
does not discriminate on the basis of race, color, religion, gender, national origin, and/or physical disabilities.
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Family History:
Father’s name: QUACH HUU DINH

Father’s employment: Employed Retired; Year Unemployed
If employed or retired, occupation: Engineering

Highest level of education attained:
None Number of primary school years Number of secondary school years
Secondary Diploma Bachelor’s Degree Master’s Degree Ph.D.
Mother’s name: PHAM THI PHUONG
Mother’s employment: Employed Retired; Year Unemployed
If employed or retired, occupation: Worker
Highest level of education attained:

None Number of primary school years Number of secondary school years
Secondary Diploma Bachelor’s Degree Master’s Degree Ph.D.
Number of siblings in your immediate family: Number of brothers: 1 Number of sisters: 0
How did you find out about the Undergraduate Intensive English Language Study Program? Check all that apply.
The American Embassy Advising Office or other Embassy contact
From a friend From a relative From a teacher or professor
From an advertisement or notice (specify the location): __________________
Other (specify how): ________________________
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ESSAYS
Please complete the following Personal Statement and Statement on Civic Engagement/Volunteering
ESSAY 1:
Personal Statement
500 word limit
Provide a clear and detailed description of who you are, including specific information about the following topics:
 Your academic objectives,
 Your goals in terms of your field of study and personal development, and
 The reasons why you wish to study the English language and how it relates to your interests and future objectives.
The essay is an important part of the selection process and will be used to place you in the appropriate program. Be sure to include any
details that highlight your personality and individuality.
Type your response here:
I am a 4rd year student at the Da Nang University of Technology. My major is electronics and
telecommunications. I am sociable, funny, so I was familiar with many friends. I like reading detective story,
novel, and going out with my friends in my spare time. I also take part in many charitable activities in my country
as well as cooperation with foreign countries such as Singapore. I was born into a family with normal economic.
So I resolve to learn well to get a good job in the future. There is thus to ensure a comfortable life about material
for old age of my parents. And it also helps me realize my dream to travel some of the world.
The future is uncertain for me, but it is important to develop a career plan that will provide financial
support and personal fulfillment over the course of my professional life. To make this transition from school to a
professional career, I am going to plan a plan that will help me stay focused and motivated in meeting my goals
and objectives. After graduation, I will seek a master's scholarship in the United States. A country that has
education development like American will facilitate me on further research. On the research in the future, I will
research on embedded systems, because it is my passion. Furthermore, this field is also important today. More
than 98% of processors applied today are in embedded systems, and are no longer visible to the customer as
'computers' in the ordinary sense. At the end of my career, I want to be recognized as a positive team leader who
can bring the best out of her subordinates and help increase profits for the company. I believe it can be achieved
due to the impact on people’s lives around me in school and out. I do realize to accomplish all that I want to, I
have to be motivated and keep a positive attitude as I continue to learn new skills. “If a thing turns you on,
you’ll be good at it; If it doesn’t, you won’t”, said by David Maister, because you have to love what you do in
order to enjoy life and produce great outcomes in your job selection. Especially now with the turmoil in the
economy, if you have a great job, you are blessed and hold on to it.
As we know that we are living in the world of globalization. English language is a common language and
is spoken in many countries. It is considered as universal language. Most of the universities worldwide include
English as one of their major subject. This language is now the most widely used language in global business and
the main language of books, newspapers, airports, air-traffic control, international business and academic
conferences, science, technology, medicine, diplomacy and advertising. Moreover, 80% of all the information in
the world's electronic retrieval systems is stored in English. So it is better to me to be good at English if I want to
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approach the human knowledge. Moreover a good knowledge of the language provides a real career advantage,
whether you aim to work for an international organization or if you intend to carry out any kind of pure or
applied research. In this era, many people are jobless eventhough they have a degree.. Eventhough, I got the best
result in examination but i cannot speak in English, it is hard for me to find a job. Example is, if I want to work
with a giant company such as Petronas, Sime Darby, Google and etc I need to face many process. One of the
process is interview. Interview is one of the important process for me to face if i want to work with a giant
company. However, they use international language that is English as a medium to communicate among the
others. Therefore, they must do an interview in English to find an employee. So English play an important role in
my life.
Please continue on to Essay 2
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ESSAY 2:
Statement on Civic Engagement/Volunteering

500 word limit
Participants in this program will take part in volunteer activities and service learning projects while in the United States. Many
volunteer opportunities will relate to either the environment (stewardship, protection, and conservation) or public health (health and
human services). Applicants are not required to have a background in these specific areas, but details about any experience or interest in
these areas should be included.
Program staff will also work with participants to develop a unique project of the participant’s choice that will be carried out in the
participant’s home country following the completion of the U.S. program component. University staff will support participants in the
implementation of their projects, after they have returned home.
Please provide an essay that responds to the following items:

 Why is volunteering in your community valuable? Do you volunteer (if yes, please explain)? Is it common for someone to
volunteer in your home country?
 What are some areas of concern for your community or country? How might volunteer program in your community make
these areas of concern better?
 While in the U.S., which type of volunteer activities, groups, or issue areas are you most interested in participating?
 What is the one thing that you hope to learn in the U.S. that will allow you to return to your community and make a positive
impact?
In today’s busy society, it can be hard to think about finding time to volunteer. However, the benefits of
volunteering are enormous, both to me, my family and the community. The right match can help me find friends,
reach out to the community, learn new skills and even advance my career. Volunteering is the ultimate payback
to those who helped me on the road to success. So in my point of view it is very important for every person to do
a volunteer at least once in a life time. I took part in many charitable activities in my country as well as
cooperation with foreign countries such as Singapore. For example in the UOM MAM project that cooperate with
Singapore Red Cross we volunteer to teach IT and English for children in the remote areas which does not have
condition to learn. In my countries there are many volunteer services and people especially pupils and students
are very enthusiasm to join. However the fund for these activities are a big problem that impede the expansion of
the volunteer organizations or agencies in my country.
There are a lot activities such as helping a child learn to read, using computer, creating a Web site, learning
English or nursing sick animals back to health or planning trees etc. However, according to me, lives of poor,
homeless and disabilities people is the most concerned area in my country. There are still many unhappy lives in
our society that need our hands. So to help these people we need to have many volunteer people, they can help
and do charity according to the condition of each person. We can propagate to let more people know more about
the importance of volunteering as well as doing charity. And the most important factor that can lead to the
success of the volunteer program is fund that we can raise from the companies or government.
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While in the US I am interested to participate in college volunteer activities or charity clubs. I want to know the
way US students do volunteer, care orphans, poor, disabled or elderly people as well as the way they make these
unhappy people smile. Americans always fascinated me with their cultures and tradition so I want to learn their
culture and traditions in real. I heard about a term ‘active volunteers’ from my American professor. I remember
that ‘active volunteer’ come in both sexes and in all sizes, shapes, colors, and personalities. An active volunteer
broadens the interests of the rest of the household by bringing them into contact with ideas outside the home and
business. Volunteerism is an active example of willingness to cooperate and help others -- and when deemed
necessary, to change the world to make it a better place in which to live. So I think when I volunteer in US I can
understand more about this term and So that when I return home I can share it with college friend and we will
discuss to apply it in our country.
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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 also authorize any school or university
which I have attended or will attend to release my transcripts and any report to the designated placement agency.
Signature: Date: ______________________________
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A program of the Bureau of Educational and Cultural Affairs, U.S.

Indicate any other spelling(s) or name(s) you use:

U.S. PROGRAM DATES:

HOME COUNTRY CONTACT INFORMATION

Additional contact information:

PERSONAL DATA AND PASSPORT INFORMATION

Sex: Male Female

Date of birth: 12 (month) / 11(day) /1989(year)

Place of birth:Ha Tinh(city),Da Nang(country)

Country of permanent legal residence: Viet Nam

Country of citizenship: ________________

University you attend: DA NANG UNIVERSITY OF TECHNOLOGY

Major field of study/interest: Embedded System

Minor field of study/interest: Philosophy

Secondary School:Nguyen Da Nang,Viet Nam From: To: Good 8.5

Have you ever been dismissed from a school or university? No Yes

If yes, please explain: ___________________________________________________________________

Native language(s): VIET NAM

Number of years of English study: 15 Where studied: School and university.

Language Name Reading Ability Writing Ability Speaking Ability

STANDARDIZED ENGLISH TEST SCORES

Test Name Date Score

Contact : Red Cross Humanitarian

I am the member of football club in my Sport From: To:

EMERGENCY CONTACT INFORMATION

PREVIOUS EXPERIENCE IN THE UNITED STATES

Father’s name: QUACH HUU DINH

If employed or retired, occupation: Engineering

Secondary Diploma Bachelor’s Degree Master’s Degree Ph.D.

Mother’s name: PHAM THI PHUONG

Mother’s employment: Employed Retired; Year Unemployed

If employed or retired, occupation: Worker

Highest level of education attained:

Secondary Diploma Bachelor’s Degree Master’s Degree Ph.D.

Number of siblings in your immediate family: Number of brothers: 1 Number of sisters: 0

The American Embassy Advising Office or other Embassy contact

From a friend From a relative From a teacher or professor

From an advertisement or notice (specify the location): __________________

Other (specify how): ________________________

Type your response here:

Please continue on to Essay 2

Statement on Civic Engagement/Volunteering

Please provide an essay that responds to the following items:

Signature: Date: ______________________________

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