The Kellner Foundation
Application for the Kellner Scholarships
PERSONAL DATA
Legal name
Last
First
Middle
If you prefer to be called by another name, please note
Gender
Age
Home Address
Street
City
State
Zip
Phone and e-mail
Mailing address (if different from above)
Street
City
Date of birth (month/day/year)
State
Zip
Place of birth
Country of citizenship
First language
Other languages spoken with fluency
Previous travel to the United States, where and for what period of time:
Previous study abroad experiences, where and for what period of time:
Insert picture here.
EDUCATIONAL DATA
College or university you now attend (include faculty or faculties)
Major(s) and minor(s), including level (BA/MA), year and specialization (e.g. English Studies BA III., Applied Linguistics specialization):
College Address
Street
City
State
Zip
College phone and fax
Expected date of graduation (without Kellner study abroad year)
Cumulative GPA
Number of academic semesters completed, including current semester and previous ones at any university or college
Academic Record: Submit a copy of your transcript. See application requirements for details.
List all colleges at which you have taken courses for credit (include school names, majors, degrees obtained, and dates of attendance).
If you have been out of school, describe your recent activities.
List all secondary schools, including summer schools, programs, and institutes, attended since the eighth grade (include school names
and dates of attendance).
List academic interests and career or professional aspirations.
Housing information:
Any special requirements
Smoker or non-smoker
FAMILY
MOTHER
Mother’s name
Place of birth
Home Address (if different from yours)
Street
City
State
Zip
Occupation (include title and organization)
College attended (include degree and year of graduation)
Graduate school attended (include degree and year of graduation)
FATHER
Father’s name
Place of birth
Home Address (if different from yours)
Street
City
State
Zip
Occupation (include title and organization)
College attended (include degree and year of graduation)
Graduate school attended (include degree and year of graduation)
List names and ages of your siblings. If they have attended or are attending college, list the institutions, degrees obtained, and dates of
attendance.
LANGUAGE EXAM
IF YOU WOULD LIKE TO TAKE THE LANGUAGE EXAM OFFERED IN THE SELECITION PROCESS, INDICATE YOUR INTEREST HERE (YES/NO)
(You will have to confirm your choice later if invited to the interviews.)
ACADEMIC HONORS AND EXTRACURRICULAR ACTIVITIES
Describe any academic honors you have received or distinctions you have attained.
Describe extracurricular, community, and family activities in which you participate.
EMPLOYMENT OR VOLUNTEER WORK
List any jobs you have held during the past three years, including summer employment.
(Note the specific nature of the work, names of employers, dates of employment, and hours worked per week.)
Briefly describe extracurricular or work activities that have had significant meaning for you, and why.
Every student has individual habits of study, patterns of development, and occasional difficulties. What can you tell us about yourself in
this regard?
My signature indicates that all the information contained in my application is factually correct and honestly presented.
Signature
Date
The Kellner scholarship program does not discriminate in admission on the basis of sex, sexual orientation, race, color, age, religion, national origin, or handicapping conditions.
The Kellner Foundation
Statement of Purpose
PLEASE WRITE TWO ESSAYS. THE ESSAYS CAN BE WRITTEN BY HAND OR TYPED.
ESSAY NO. 1. Please describe in 1 page (A4) why you wish to study in the USA (do not exceed this page). Describe in detail your main interests and
experience in social, political, cultural or economic topics and how your study in the United States would benefit your long term goals.
ESSAY NO. 2. Please write your thoughts regarding a current social, political or economic topic of your choice. For example, you may want to discuss a
particular aspect of one of the following topics: economic development, social change, business and society, corruption, political leadership today, role
of ethnic minorities, individual rights. You may also choose another subject – pick a topic that intrigues and engages you and explain its importance as
well as your personal involvement/contribution. This essay must be about 1.5-2 pages (A4) long.