Name of Applicant:
Country: Argentina
Fulbright –City of Buenos Airs Grants
Foreign Language Teaching Assistant Program
A. PERSONAL INFORMATION
1. Name of applicant EXACTLY AS APPEARS IN PASSPORT
(Enter Full Name; underline family name)
First:
Middle:
Last:
2. Gender
Male
Female
3. Permanent Address
Street address and number:
City:
Zip Code:
State/ Province:
4. Telephone number (please, add area code):
5. Cell phone number (please, add area code):
6. Email (please, enter the email address that you check regularly):
7. Place of birth (city or town and country):
8. Date of birth (month/day/year):
9. Country of your present citizenship:
10. Marital status (single, married, widowed or divorced):
11. Age of children, if any:
12. How did you learn about this Program?
Friendo or relative:
Fulbright social media:
Fulbright mailing:
Fulbright webpage
Education USA:
U.S.Embassy mailing/social media:
Other (please, explain):
13. Are you willing to perform actual classroom teaching duties?
Yes
No
OR
Do you prefer to have primarily an assistant role (e.g. language lab supervision,
Name of Applicant:
tutoring, animating conversation groups, etc.?)
Yes
No
OR
Both options are acceptable to you:
Yes
No
Country: Argentina
Name of Applicant:
Country: Argentina
B. OBJECTIVES
Write a clear and detailed description of your objectives. Give reasons for wanting to participate in
the program. Explain how the FLTA Program fits with your previous education/training and your
future objectives. Describe your future plans.
THIS STATEMENT IS AN IMPORTANT PART OF YOUR APPLICATION.
Name of Applicant:
Country: Argentina
C. NON-ACADEMIC INTERESTS
Please list any non-academic interests (e.g. sports, music, art, etc) Include information about your
experience in these areas.
D. FUTURE PLANS
DESCRIBE THE CAREER YOU PLAN TO PURSUE AFTER COMPLETION OF A YEAR IN THE
U.S. e.g. teaching, government, business, or any plans of continued research in your home
country. Also, indicate if you will be returning to former employment, or if you have been promised
a position in your home country after completing the U.S. experience. If yes, please describe.
E. LANGUAGE PROFICIENCY
(If you have taken any standard test of English language proficiency, please provide copy of the
test results. At most U.S. institutions, TOEFL results are preferred.
14. Test Taken:
15. Date Taken:
16. Results (Please attach copy):
17. Knowledge of languages including English: Rate yourself Excellent, Good, Fair or
Poor. Include all languages in which you have some competence. Indicate mother tongue.
Language
Reading
Writing
Speaking
Name of Applicant:
Country: Argentina
F. EDUCATION
18. LIST EDUCATIONAL INSTITUTIONS ATTENDED
Name of
Institution/Location
Major Field
of Study
Dates
(Month and year)
From
To
Actual Name of
Degree or
Diploma
(Do not
translate)
Date
Received or
Expected
University or
Professional
Secondary
19. LIST SCHOLARSHIPS OR FELLOWSHIPS HELD AT PRESENT OR IN THE PAST:
(Give source or sponsor, amount, where held, and duration and year)
20. INDICATE ACADEMIC HONORS OR PRIZES WHICH YOU HAVE RECEIVED:
F. EDUCATION
G. OCCUPATIONAL EXPERIENCE:
21. LIST POSITIONS HELD (begin with most recent employment; add as many rows as
necessary)
Name and address of employer
Type of work (Position Held)
Dates
GPA
Name of Applicant:
Country: Argentina
22. LIST PROFESSIONAL SOCIETIES, FRATERNITIES OR OTHER ORGANIZATIONS IN
WHICH YOU NOW HOLD MEMBERSHIP OR IN WHICH YOU HAVE BEEN ACTIVE IN THE
PAST (Indicate if you have held elective office)
H.
H. REFERENCES
OTHER
23. PROVIDE THE NAMES OF TWO INDIVIDUALS WHO MAY BE ABLE TO WRITE LETTERS
OF RECOMMENDATION FOR YOU (please, make sure to indicate the names of referents who
may provide the actual letters during the holiday season).
Full Name
Position and Email
Referent’s affiliation
in Argentina
I. OTHER
24. IF YOU HAVE TRAVELED OR LIVED IN ANY COUNTRY OTHER THAN YOUR OWN
INDICATE PLACES, DATES AND REASONS.
25. Provide the name, address and telephone number of individuals to be notified in case
of emergency
In Home Country
In the United States
List Below any close relatives
or friends in the United States
(name, address, and
relationship)
Name of Applicant:
Country: Argentina
26. Please describe any physical impairment you may have (This information is gathered for
statistical purposes and to ensure appropriate placement. The program does not discriminate on
the basis of race, color, religion, sex, national origin, and/or physical impairment)
J. PERSONAL STATEMENT
The curriculum vitae should be a narrative statement concerning your personal history and future
plans; it should not be a mere listing of facts. It should include information about your background
education, practical experience, special interests, career plans, and your purpose in applying for
this teaching assistantship in the United States. Describe any significant influences on your
personal and educational development. Comment on the number of years of practical experience
already completed in your field and describe briefly the most advanced courses already pursued.