UNITED STATES-INDIA EDUCATIONAL FOUNDATION Fulbright House, 12 Hailey Road, New Delhi 110 001 Preliminary Application Form

for 2013-2014 Fulbright-Nehru Masters Fellowships for Leadership Development

1.

Submit your completed application to [email protected] along with your curriculum vitae or resume as attachments. Your CV should provide a complete picture of your educational background, work experience and all major accomplishments (publications, awards, memberships in associations etc.). It should not exceed 3 typed pages. Do not include any photographs. Warning: Plagiarism in the application will lead to disqualification. Your application along your CV should not exceed 4 MB. Please indicate your full name and grant category in the subject line of your email. For instance, if your name is Amit Sharma, you should write Amit Sharma FulbrightNehru Masters Application, in the subject line.

2.

Print out the copy of your application and sign it. If you are not employed, please forward the signed copy with the following enclosures to the USIEF office in your region. If you are employed, you should forward the signed copy of your application through proper channel with the following enclosures to reach USIEF by the application deadline. Self attested photocopies of mark sheets and diploma/degree certificates from bachelors degree onwards. Self-attested photocopies of proof of your work/professional experience, if applicable Photocopies of test score reports (TOEFL, GRE or GMAT), if applicable Photocopies of writing samples, if any Photocopies of correspondence with U.S. Universities If you have a deferred admission, please attach a scanned copy of the deferral letter from the U.S. University

All applicants are advised to request three referees to send their recommendations on the prescribed Masters Confidential Letter of Reference forms to Executive Director, USIEF, Fulbright House, New Delhi no later than the application deadline. These forms can be downloaded from the USIEF website.

ii

UNITED STATES-INDIA EDUCATIONAL FOUNDATION

Preliminary Application Form for 2013-2014 Fulbright-Nehru Masters Fellowships for Leadership Development
[Application must be computer generated]

1.

Name:

[Surname/Family Name]

[First Name] [Middle Name]

2.

Gender: Male Married

Female

Marital Status: Single Age:

Date of Birth: [dd/mm/yy] 4. 5.

Place of Birth:

Country of Citizenship:

Current Position and Address (if applicable):

Phone: [Office] 6. Name of Degree/Diploma Senior Secondary Intermediate, Higher Secondary, 10 + 2 etc. (specify) Bachelors (specify degree and indicate

[Fax]

[E-mail]

Academic Record: Please list educational institutions currently attending/have attended. Name and Address of Institution Major Subject From Year To Percentage

iii

duration) Masters (specify degree and indicate duration) Any other professional or technical degree

a)

7.

Proposed Field of Study [Choose one]: Arts and Culture Management including Heritage Conservation and Museum Communication Studies Conflict Resolution Economics Environment Public Administration Urban and Regional Planning Womens Studies

Studies

b)

Area of Specialization that you wish to pursue (Please refer to the Eligible Fields of Study descriptions in the announcement)

8. Employment Record: List up to three paid/voluntary employments beginning with the latest. Describe the mission of each office where you worked and describe each position you have held listing two most important roles/functions in the Job Profile/Responsibilities. [Note: To be eligible, you must have at least three years full-time [paid or voluntary] professional work experience in an area directly relevant to your chosen field of study.] Name of Employer/Organization: Mission of the Organization:

I)

Your designation:

Period of Employment: From:

To:
Your Job Profile: [List two most important roles/functions] 1. 2. II)

Name of Employer/Organization: Mission of the Organization:

Your designation:

Period of Employment: From:

To:
Your Job Profile: [List two most important roles/functions] 1.

iv

2.

III)

Name of Employer/Organization: Mission of the Organization:

Your designation:

Period of Employment: From:

To:
Your Job Profile: [List two most important roles/functions] 1. 2.

9. Please list community service, sports or cultural activities in which you have participated regularly in the past five years. If you were a team leader, council member or other officer in any institution or activity, please note that as well. Type of activity Institution Duration of participation From To

10. Please indicate any scholarships, awards, honors that you have received, with titles and dates.

11. List any books, articles or theses published by you especially in your proposed field of study.

12. Have you traveled, lived, or studied in any country other than your own? If yes, please indicate places, dates and reasons.

13. The following questions are designed to provide us with more information about you. They are an important part of your application. Do not exceed 20 lines of text for ANY TWO of the following questions:

If you were given one year to spend in service on behalf of others, what would you choose to do, and why?

Indicate a person who has had a significant influence on you, and describe that influence.

Please describe incidents in your personal and professional life where you show your leadership. Give one example each.

Imagine that it is the year 2020. What will you be doing, and where?

vi

14. Statement of Purpose: Write a detailed essay which describes your future career plans, why you want and need to study in the U.S. at the graduate level. Also explain how your study plan fits in with your previous academic/professional training and future objectives. Describe how you will utilize the U.S. academic experience on your return to India. Your statement is an essential part of your application. Please use only the space provided. Your answer should not exceed 50 lines of text:

vii

15. Personal Statement: This should be a narrative statement showing your strengths as a candidate for this fellowship. It should include information about your education, practical experience, special interests and any significant factors/accomplishments that have influenced your educational or professional development which distinguishes you from others and which you would like to bring to the attention of the Selection Committee. Please use only the space provided. Your answer should not exceed 50 lines of text:

16.

The purpose of the Fulbright Program is the promotion of mutual understanding among people from the U.S. and other nations. This involves more than academic/professional work. During your Fulbright grant, do you anticipate becoming involved in any way with your host society beyond the scope of your immediate academic objectives? If yes, explain how. If no, why not? Please use only the space provided. Your answer should not to exceed 15 lines of text:

17. University Preferences: It is not a requirement nor is it expected for you to identify U.S. institutions at which you would like to study. However, if you do have preferences, please list in order of priority four schools of your choice. Indicate specific departments and/or programs. Provide specific reasons for each choice. If you have already submitted an application form directly to any university in the U.S. or are in contact with professors, please attach copies of correspondence. Provide names, e-mails, and/or phone contacts for professors you are in touch with. Your preferences will be taken into consideration as far as possible. If you have applied to an institution earlier and have received a deferral, please attach a copy of the deferral letter. Please note that should you be recommended for the FulbrightNehru Masters Fellowship, then USIEF will not apply to any other institution and will seek confirmation of placement only at the deferred institution. Name of University Department Specialization/Concentration Specific Reasons Contacts/E-mails Professors of

18. Testing: If you have not taken the Test of English as a Foreign Language (TOEFL), Graduate Records Examination (GRE) or the Graduate Management Admission Test (GMAT) and are selected as a finalist, you will be required to take the TOEFL, GRE, TSE, or GMAT exams and submit the score reports to us and USIEF will cover the test fees. If you have previously taken any of the above mentioned examinations, please give your score and date and place where you took the examination. Attach copy of your score report to the application if available. Date (mm/yy) TOEFL TSE GMAT Score Percentile Date (mm/yy) GRE General Exam GRE Subject Exam Verbal Score Percenti le Quantitati ve Score Percentile Analytical Score

Date (mm/yy)

Score

Percenti le

Subject Name

Other

viii

Other Test Name

19. Recommendations: List below names of three referees with their designation and contact details. Please request the referees to complete a frank evaluation about you as an individual, and a scholar on the prescribed Reference Report Form and comment specifically on your study plans. The referee may be a supervisor at work, a professor/academic advisor/dean, or a community leader who is familiar with your academic and/or professional work. Please request your referees to send their letters of reference directly to the Executive Director, USIEF, 12 Hailey Road, New Delhi 110 001, so as to reach by the application deadline. 1. 2. 3. 20. Do you have a valid Passport? Yes If yes, please mention: Passport No. No Date of Expiry:

21. Current Mailing Address:

Phone: [Res.]

[Mobile]

[E-mail]

22. Permanent Residence Address [specify if different from the Current Residence address]:

Phone: [Res.]

Residence

23. Indicate preferred mailing address [please tick any one]: Office Permanent Home Address

24. Name, address and relationship of person to be contacted in India in case of emergency.

Phone: [Res.]

[Mobile]

[E-mail]

25. Employer's Comments [if employed]: Must be filled-in by the Administrative Head of the institution and not the immediate supervisor. Your opinion about the usefulness of the program to the institution as well as to the applicant on his/her return from the U.S. is invited. Please indicate whether the applicant, if selected, will receive leave for the grant period.

ix

Employer's Signature Official Seal: Date: Name Designation

: : :

26. How did you learn about this Fulbright fellowship? (Please indicate all that apply) Friend or relative Previous Fulbrighter Poster/Flyer University (specify) Newspaper (specify) Other Publication (specify) USIEF Website Internet Link Other (specify)

Fulbright Presentation (specify)

27. Please read carefully and sign: I confirm that I have reviewed the general prerequisites for all Fulbright applicants and any specific guidelines pertaining to the Fulbright-Nehru Masters Fellowship for Leadership Development. I understand that any incomplete application, or application falsified by omission or misinformation will automatically be disqualified. I agree to inform USIEF about any overseas travel plans during the application cycle (July 2012 to June 2013). I also understand and agree that if a grant is awarded to me for study in the United States: I will complete the prescribed course contemplated by the grant unless released as outlined for me by those under who supervision I will be placed. I will abide by the policy guidelines established by the J. William Fulbright Foreign Scholarship Board in connection with the grant. I understand that initial selection in India does not guarantee me final placement and an award.

_____________________________________ Date (dd/mm/yy) Applicant

Name and Signature of the