Youth Summer Leadership Institute Application
YSLI Application
YOUR NAME
(as it appears on your passport) Family First
(Submit a copy of your passport)
Permanent mailing address:
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ID #:
Mobile telephone:
Home telephone:
E-mail address:
PERSONAL INFORMATION
Date of Birth:
Day / Month / Year
Country of Citizenship:
Country of Residence:
Country of Birth:
City of Birth:
ACADEMIC INFORMATION
University Name:
Year in University:
Major Field:
(e.g. economics, science, business, English, etc.)
Minor Field:
(if applicable)
College or University – First Year
(excluding orientation year)
College or University – Second Year
(excluding orientation year)
REFERENCES
Please provide the name of a teacher or professor who has agreed to
serve as a reference for your application.
Reference Name:
Title:
Email address: Mobile Phone:
YOUR NAME
(as it appears on your passport) Family First
EDUCATIONAL BACKGROUND
Please provide complete information about all the educational institutions
that you have attended or are attending for your secondary
and undergraduate education.
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Institution Name |
Institution Location (City, Country) |
Dates Attended MM/YY – MM/YY |
Major / Minor Fields |
GPA |
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College/University: |
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Secondary School: |
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Please explain any gaps in your education:
HONORS/AWARDS
Please list any special honors or awards you have received:
ENGLISH PROFICIENCY
Speaking: Excellent
Good
Fair
Reading: Excellent
Good
Fair
Writing: Excellent
Good
Fair
WORK EXPERIENCE (if applicable)
Please start with your most recent position.
You may include volunteer activities and internships.
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Name of Employer and Location |
Your Job Title and Responsibilities |
Dates of Employment MM/YY – MM/YY |
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YOUR NAME
(as it appears on your passport) Family First Middle
(Submit a copy of your passport)
EXTRACURRICULAR ACTIVITIES (if applicable)
Please describe any activities, clubs, or organizations in which you participate.
You may include volunteer and sports activities.
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Name of Activity |
Describe the activity and your role |
Dates of Involvement MM/YY – MM/YY |
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MEMBERSHIPS (if applicable)
Please list your membership in any other organizations:
SPECIAL INTERESTS (if applicable)
Please describe any hobbies or special interests:
UNITED STATES EXPERIENCE
Please describe any previous travel or study in the United States.
If you have not traveled to the United States, indicate “none.”
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Travel Dates MM/YY – MM/YY |
Travel Purpose (e.g. vacation, school, etc.) |
US Government Program? Y/N |
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YOUR NAME
(as it appears on your passport) Family First Middle
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SHORT ESSAY #1 What are your career goals? How will leadership training help to prepare you to meet these goals? |
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SHORT ESSAY #2— Identify one political, social, or economic challenge facing your country today. What steps could be taken to solve the problem or improve the situation? What role can students play in this process? |
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DISCLAIMER (all applicants) The information in this application is accurate and complete. The written work in the short essays is my own and I have not been assisted by any other person. I understand that I may be required to verify information in this application by providing documentation including (but not limited to) transcripts, test scores, and writing samples. I also understand that intentionally falsifying information in this application could be grounds for disbarment from U.S. Government funded exchange programs. Signature: Date: |