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FULBRIGHT PROGRAM

APPLICATION FOR STUDY IN THE UNITED STATES


FOR A FELLOWSHIP, SCHOLARSHIP, ASSISTANTSHIP OR OTHER EDUCATIONAL GRANT
(Please read instructions carefully. All sections should be completed in English and be typewritten.)

Photo

1. NAME OF APPLICANT Mr. Ms. Family First Middle Initial

2. NAME ON PREVIOUS ACADEMIC RECORDS: (If different from above)

. 3. PERMANENT ADDRESS: 4. HOME PHONE:

5. DATE OF BIRTH: (Month-Day-Year) 9. BIRTHPLACE: (City, State/Province, Country)

6. GENDER: Male Female

7. OFFICE PHONE: 8. EMAIL:

10. COUNTRY OF RESIDENCE: 12. AGES OF CHILDREN, IF ANY:

11. MARITAL STATUS: (Single, Married, Divorced, Separated, Widow, Widower, etc.) 13. CITIZENSHIP:

13.a

DO YOU NOW HAVE, OR HAVE YOU EVER HELD: U.S. CITIZENSHIP? DUAL CITIZENSHIP? U.S. PERMANENT RESIDENCY? Yes Yes Yes No No No

13.b HAVE YOU EVER APPLIED FOR A U.S. VISA? IF YES, WHEN?

Yes

No Yes No No IF YES, WHAT TYPE OF VISA?

WAS THE VISA GRANTED? Yes

DO YOU HAVE IMMEDIATE RELATIVES IN THE U.S.?

IF YES, EXPLAIN RELATIONSHIP:

STUDY PLANS
14. WHAT IS YOUR PROPOSED MAJOR FIELD OF STUDY AND IN WHAT SPECIFIC AREA OF YOUR FIELD DO YOU PLAN TO SPECIALIZE? PLEASE REFER TO THE LIST OF MAJORS ENCLOSED. MAJOR: SPECIFIC AREA:

15. DEGREE OBJECTIVE:

Doctorate

Masters

Non-Degree

Visiting Researcher

EXAMINATION RESULTS
16. EXAMINATION DATES AND TEST SCORES: (Date if taken or future date for taking exams (Month/Year)) Date Score Percentile Date GRE General Exam Date GRE Subject Exam Verbal Score % Quantitative Score % Analytical Score %

TOEFL TSE TWE GMAT IELTS

Score

Subject Name

EDUCATION
17. LIST EDUCATIONAL INSTITUTIONS ATTENDED IN REVERSE CHRONOLOGICAL ORDER, INCLUDING ANY IN WHICH YOU MAY BE PRESENTLY ENROLLED:

INSTITUTION AND LOCATION (List in reverse order)

MAJOR FIELD OF STUDY

DATES (Month and Year) From To


ACTUAL NAME OF DEGREE OR DIPLOMA (Do not translate)

DATE RECEIVED OR EXPECTED

18. LIST SCHOLARSHIPS OR FELLOWSHIPS HELD AT PRESENT OR IN THE PAST: (Give source or sponsor, amount, where held, and duration.)

19. INDICATE ANY ACADEMIC HONORS OR PRIZES WHICH YOU HAVE RECEIVED, WITH TITLES AND DATES;

20. LIST ANY BOOKS, ARTICLES OR THESES PUBLISHED BY YOU, ESPECIALLY IN YOUR PROPOSED FIELD OF STUDY: (Give title, place and date of publication)

21. 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 an elective office.)

22. TEACHING EXPERIENCE: (Including any teaching positions you have held or currently hold.)

23. RESEARCH: (Including any research you have completed or in which you are currently involved.)

Application Page 3 Application Page 2

NAME OF APPLICANT:
24.

COUNTRY:

STUDY OBJECTIVES
Write a clear and detailed description of your study objectives. Be specific about your major field and your specialized interests within this field. Describe the kind of program you expect to undertake, and explain how your study plan fits in with your previous training and your future objectives. Your statement is an essential part of your application. Unclear, incomplete or impractical proposals can result in your being referred to a university not suited to your scholastic needs, or your not being accepted by any university. Do not mention specific U.S. universities at which you would like to study. Do not exceed the space available. If you need additional space, please prepare a separate sheet and insert it after printing the application.

Application Page 4

NAME OF APPLICANT:
25.

COUNTRY:

PERSONAL STATEMENT
Please provide a narrative statement discussing your professional, academic and future plans. It should not be a mere listing of facts. It should include information about your education, practical experience, special interests, career plans, and your purpose in applying for study in the U.S. Describe any significant factors that have influenced your educational or professional development. Comment on the number of years of practical experience already completed in the field in which academic work will be done in the U.S. and describe briefly the most advanced courses already pursued in their field of study. Do not mention specific U.S. universities at which you would like to study in your Personal Statement. Do not exceed the space available. If you need additional space, please prepare a separate sheet and insert it after printing the application.

Application Page 5

NAME OF APPLICANT:

COUNTRY:

26. KNOWLEDGE OF LANGUAGES: (Rate yourself Excellent, Good or Fair. Include all languages in which you have some competence.) Mother Tongue READING WRITING SPEAKING

LANGUAGE English

26.a HOW MANY YEARS HAVE YOU STUDIED ENGLISH?

27. OCCUPATIONAL EXPERIENCE: (List positions held, beginning with the most recent employment, if any.) NAME AND ADDRESS OF EMPLOYER TITLE/TYPE OF WORK DATES (Month and year) From To

28. IF YOU HAVE TRAVELLED, LIVED, OR STUDIED IN ANY COUNTRY OTHER THAN YOUR OWN FOR MORE THAN A MONTH, INDICATE PLACES, DATES AND REASONS:

29. PLEASE PROVIDE THE NAME, ADDRESS AND TELEPHONE NUMBER OF INDIVIDUALS TO BE 30. PLEASE LIST ANY CLOSE RELATIVES OR NOTIFIED IN CASE OF AN EMERGENCY: FRIENDS IN THE UNITED STATES: (Name, address and relationship) IN YOUR HOME COUNTRY IN THE UNITED STATES

31. PLEASE DESCRIBE ANY PHYSICAL IMPAIRMENT YOU MAY HAVE: (This information is gathered for statistical purposes and to ensure appropriate placement. IIE does not discriminate on the basis of race, color, religion, sex, national origin, and/or physical impairment.)

32. FUTURE PLANS: (Describe the career you plan to pursue after completion of study or research in the U.S. (e.g., teaching, government, business, industry or any plans you might have for continued study or 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 your U.S. training).

BY MY SIGNATURE, I CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE, THE INFORMATION PROVIDED IN MY APPLICATION IS ACCURATE AND COMPLETE. SIGNATURE OF APPLICANT: DATE: Application Page 6

FULBRIGHT PROGRAM
APPLICATION FOR STUDY IN THE UNITED STATES
FOR A FELLOWSHIP, SCHOLARSHIP, ASSISTANTSHIP OR OTHER EDUCATIONAL GRANT
CONFIDENTIAL LETTER OF REFERENCE
This letter of reference must be written by a teacher under whom the applicant has studied or pursued research in the proposed field of study or by someone who has supervised the applicant in work related to the proposed field of study. This letter must be typewritten and in English. If not in English, then an accurate translation must be attached. NAME OF APPLICANT: NAME OF REFEREE: TITLE COUNTRY:

INSTITUTION OR BUSINESS

1. HOW LONG HAVE YOU KNOWN THE APPLICANT?

2. IN WHAT CAPACITY HAVE YOU KNOWN THE APPLICANT? (mark one of the boxes below) Teacher or Professor Employer or Job Supervisor Research Adviser Other (Please specify)

3. PLEASE PROVIDE A CANDID EVALUATION OF THE APPLICANTS PAST PERFORMANCE AND ABILITY TO PURSUE AND SUCCESSFULLY COMPLETE A PROGRAM OF STUDY IN THE PROPOSED FIELD. Your statement will be given considerable importance by the universities reviewing this students application and should, therefore, be as complete and detailed as possible. Your comments should be continued on the following page if more space is required.

Confidential Letter of Reference Page 1

4. IN THIS RATING CHART, PLEASE EVALUATE THE APPLICANT IN COMPARISON WITH OTHER STUDENTS WHOM YOU HAVE KNOWN DURING YOUR POFESSIONAL CAREER. Excellent Intellectual Ability Knowledge of Field Work Habits Motivation to Pursue Graduate Study Seriousness of Purpose Potential For Significant Future Contribution in Field Resourcefulness and Initiative Emotional Maturity Adaptability to New Situations Leadership Qualities Teaching Potential Very Good Average Below Average

NAME (print):

SIGNATURE:

DATE:

PLEASE PLACE IN A SEALED ENVELOPE TO BE RETURNED DIRECTLY TO: SELECTION COMMITTEE, FULBRIGHT COMMISSION IN ECUADOR, ALMAGRO N25-41 Y COLON, QUITO, ECUADOR. UNDER NO CIRCUMSTANCES SHOULD THE COMPLETED FORM BE RETURNED TO THE APPLICANT IN AN UNSEALED ENVELOPE. NOTE: The Fulbright Commission in Ecuador cannot guarantee this letters confidentiality once it becomes part of its records.

LIST OF MAJORS
AGRICULTURE 1. AGRICULTURAL ECONOMICS a. Agribusiness b. Agricultural Finance c. Agricultural Marketing d. Agricultural Policy e. Farm Management f. Land Economics g. Natural Resource Economics h. Production Economic 2. AGRICULTURAL ENGINEERING a. Agricultural Waste Management b. Food Engineering c. Food Engineering/Process Control d. Forest Engineering e. Handling/Processing/Storage of Agricultural Products f. Irrigation & Drainage Systems/Engineering g. Post-harvest Technology h. Power & Machinery i. Soil & Water Engineering j. Wind Erosion 3. AGRICULTURE a. Agronomy b. Animal Nutrition c. Dairy Science d. Fruit/Vegetable Production e. Horticulture f. Ornamental Horticulture g. Pest Control/Entomology h. Plant Breeding/Genetics i. Plant Pathology j. Plant Science k. Tropical Agriculture 4. NATURAL RESOURCES a. Forestry b. Natural Resource Management c. Range Management d. Fish, Game and Wildlife Management e. Environmental Science 5. VETERNARY MEDICINE a. Theriogenology b. Toxicology c. Surgery d. Neurology e. Small-animal Medicine f. Large-animal Medicine ENGINEERING 10. AEROSPACE & MECHNICAL ENGINEERING a. Acoustics b. Aerodynamics c. Aeroelasticity d. Aeronautical & Astronautical Systems e. Air Conditioning and Ventilation f. Applied Mechanics g. Computer-aided Design h. Design and Systems Analysis i. Energy Systems j. Flight Dynamics and Control k. Fluid Mechanics l. Gasdynamics m. Guidance and Control n. Heat Transfer o. Instrumentation p. Manufacturing Processes and Design q. Propulsion r. Solid Mechanics s. Structural Dynamics t. Structural Mechanics u. Thermal Science 11. CHEMICAL ENGINEERING a. Bio-chemical Engineering b. Catalysis & Kinetics c. Coal Conversion d. Colloid /Interfacial Sciences e. Heat/Mass Transfer f. Pollution Control g. Polymer Processing h. Process Synthesis and Design i. Reactor Engineering j. Rheology k. Separation Processes l. Transport Phenomena 12. CIVIL AND ENVIRONMENTAL ENGINEERING a. Construction Engineering/Management b. Environmental/Sanitary Engineering c. Geodesy/Survey Engineering d. Geotechnical Engineering/Soil or Rock Mechanics/Earthquake e. Structural Engineering f. Transportation Engineering g. Water Resources Engineering/Hydaulics/ Hydrology 13. ELECTRICAL ENGINEERING a. Biomedical Engineering b. Computer Engineering (hardware) c. Control Engineering d. Network/Systems Engineering e. Power Engineering f. Robotics g. Telecommunications h. Electromagnetics 14. GEOLOGICAL, PETROLEUM & MINING ENGINEERING a. Drilling Engineering b. Enhancing Oil & Gas Recovery c. Exploration & Development d. Mine Planning/Design e. Mine Ventilation f. Petroleum Refining g. Reservoir Engineering h. Rock Mechanics i. Well Logging 15. a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. INDUSTRIAL & SYSTEMS ENGINEERING & OPERATIONS RESEARCH Applied Probability and Statistics Artificial Intelligence Computer Integrated Management Energy Management Engineering Economics Engineering Management General Operations Research Health Systems Engineering Human Factors Engineering (Ergonomics) Industrial Robotics Manufacturing/Production Systems Production Management Quality Control/Reliability Simulation Systems Safety Engineering Stochastic Processes Systems Analysis and Design Technology Management 16. MATERIALS SCIENCE & METALLURGICAL ENGINEERING a. Alloy and Crystal Science b. Ceramic Engineering c. Chemical Metallurgy d. Corrosion Science e. Electronic Materials f. Extractive Metallurgy g. Mechanical Metallurgy h. Physical Metallurgy i. Polymer Materials j. Welding Engineering 17. a. b. c. d. e. f. g. h. i. j. k. 18. a. b. c. d. e. f. NUCLEAR ENGINEERING Applied Radiation Physics Applied Solid State Physics Fission Fusion Nuclear Fuels and Materials Nuclear Physics Nuclear Power Plant Design Plasma Physics Quantum Electronics Radiation Measurement Reactor Engineering OCEAN ENGINEERING Coastal & Offshore Engineering Marine Hydrodynamics Naval Architecture Ocean Engineering Power Systems Ocean Engineering Transportation Systems Underwater Acoustics

PHYSICAL SCIENCES 19. a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. r. s. t. 20. a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. 21. a. b. c. d. e. f. g. h. i. j. k. 22. a. b. ASTRONOMY & PHYSICS Acoustics Astronomy Astrophysics Atomic/Molecular Physics Biophysics Chemical Physics Condensed Matter Fusion and Plasmas High Energy, Elementary Particles and Fields Laser Physics Low Temperature Physics Medical & Health Physics Nuclear Physics Optics Physics Education Polymer Physics Solid State Physics Spectroscopy Statistical & Thermal Physics Theoretical Physics BIOLOGICAL SCIENCES Bacteriology Biochemistry Botany Ecology Entomology Epidemiology Genetics Immunology Marine Biology Microbiology Molecular and Cell Biology Neurobiology Parasitology Virology Zoology CHEMISTRY Analytical Chemistry Chemical Physics Crystallography Environmental Chemistry Inorganic Chemistry Nuclear Chemistry Organic Chemistry Pharmaceutical Chemistry Physical Chemistry Polymer Chemistry Theoretical Chemistry COMPUTER SCIENCE Reference Page 2 Confidential Letter Artificial Intelligence Automation Technology

THE ARTS 6. DANCE a. Ballet b. Dance Education c. Modern Dance 7. FINE AND APPLIED ARTS a. Art Education b. Computer Art c. Crafts d. Filmmaking e. Graphic Design f. Illustration g. Painting and Drawing h. Photography i. Printmaking j. Sculpture 8. MUSIC a. Music Education b. Music History and Literature c. Musicology d. Performance e. Theory and Composition 9. THEATER ARTS a. Acting b. Costume c. Design d. Directing e. Dramaturgy & Dramatic Criticism f. Playwriting g. Stage Design h. Stage Management i. Technical Design & Production

c. d. e. f. g. h. i. j. k. l. m. n. 23. a. b. c. d. e. f. g. h. i. 24. a. b. c. d. e. f. g. h. i.

Computer Design Computer Graphics Database Theory & Management Image Processing Management Information Systems Microprocessors Numerical Analysis Programming Languages Robotics Software Engineering Switching Theory Information Science GEOSCIENCES Atmospheric Sciences and Meteorology Geology Geophysics Hydrology Mineralogy Oceanography Paleontology Petrology Seismology MATHEMATICS Mathematics Applied Mathematics Pure Mathematics Probability/Statistics Computer Science Computer Programming Data Processing Information Sciences & Systems Systems Analysis

p. q. r. s. t. u. v. w. x. 30. a. b. c. d. e. f. g. h. 31. a. b. c. d. e. f. g. h. i. j. k. l. m. 32. a. b. c. d. e. f. g. h. i. j. k. 33. a. b. c. d. e. f. g. h. i. j. k. l. 34. a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. r. 35. a. b. c. d. e. f. g. h.

International Education Language Arts Education Mathematics Education Physical Education and Recreation Remedial Reading Science Education Special Education Teaching English as a Second Language Vocational Education HEALTH SCIENCES AND NURSING Allied Health Professionals Food Science/Nutrition Occupational Therapy Pharmacology Pharmacy Physical Therapy Public Health Speech Pathology/Audiology JOURNALISM AND MASS COMMUNICATIONS Advertising Broadcast Journalism Communication Theory and Research Development Communications Health Communication International Communications Media Management Photojournalism Political Communication Print Media/Journalism Public Relations Science Journalism Speech Communication LAW Administrative Law Comparative/International Law Constitutional Law Corporation/Commercial Law Criminal Law Environmental Law Human Rights Labor Law Law of the Sea/Maritime Law Natural Resource Law Taxation LlBRARY SCIENCE Academic Librarianship Archives & Manuscript Administration Information Science Law Librarianship Library Management & Administration Medical/Health Science Librarianship Music Librarianship Organization of Library Collections Public Librarianship Rare Books and Special Collections Reference and Bibliographic Material School Librarianship PUBLIC ADMINISTRATION Comparative Administration & Development Economic Development Environmental and Resource Management Health Policy & Social Welfare Health Services Administration International Affairs and Development Management Local Government Administration Population Research Public Affairs Management Public Finance Administration Public Management Information Systems Public Personnel/Human Services Administration Public Policy Analysis Public Sector Labor Relations Science Policy Technology & Information Policy Telecommunications Management Urban Affairs/Urban Management SOCIAL WORK Family & Childrens Services Health Care Systems Industrial Social Welfare Social Policy, Administration & Community Development Social Services for the Aging/Gerontology Social Theory Social Welfare Administration Social Work Research

36. a. b. c. 37. a. b. c. d. e. f. g. h. i. j. k.

TEACHING ENGLISH AS A SECOND LANGUAGE Applied Linguistics Bilingual/Bicultural Education Foreign Language Education URBAN & REGIONAL PLANNING Community Services Planning Developing Countries Economic Development Environmental Planning Housing Land Use & Developmental Planning Planning Design Planning Methods & Theories Public Policy Analysis Transportation Planning Urban/Regional Planning

SOCIAL SCIENCES & THE HUMANITIES 38. AMERICAN STUDIES

39. Anthropology a. Anthropological Linguistics b. Archaeology c. Cultural/Social Anthropology d. Ethnology e. Historical/Prehistorical Anthropology f. Medical Anthropology g. Physical Anthropology h. Urban Anthropology 40. a. b. c. d. e. f. g. 41. a. b. c. 42. a. b. c. d. e. f. g. 43. a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. r. s. t. u. v. w. x. y. z. aa. bb. cc. dd. ee. 44. 45. a. AREA STUDIES African Studies Asian Studies Eastern European Studies Judaic Studies Latin American Studies Middle Eastern Studies Womens Studies ART HISTORY & ARTS ADMINISTRATION Conservation/Restoration Museum Studies Visual Arts CREATIVE WRITING & LITERATURE American Literature Classics Comparative Literature Feminist Literature English Literature Foreign Language Literature Pedagogy ECONOMICS Community Development Consumer Economics Demographic Economics Econometric, Statistical & Mathematical Methods Economic Development Studies Economic Education Economic Fluctuations and Forecasting Economic Growth, Development and Planning, Theory and Policy Economic History Economic Systems Economics of Technological Change Energy Economics Environmental Economics General Economic Theory History of Economic Thought, Methodology International Finance International Investments & Aid International Trade Policy Labor Markets, Public Policy Law and Economics Marcoeconomics Manpower Training and Allocation Mathematical Economics Medical Economics Microeconomics Political Economics Regional Economics Resource Economics, Land Economics Social Economics Trade Unions, Collective Bargaining, LaborManagement Relations Urban Economics HISTORY INTERNATIONAL RELATIONS & POLITICAL SCIENCE Comparative Politics

PROFESSIONAL & EDUCATIONAL STUDIES 25. ARCHITECTURE a. Architectural History b. Historic Preservation c. Environmental Design d. Industrial Design e. Interior Design f. Landscape Architecture g. Urban Design h. General Architecture: Design, Theory, Methods 26. a. b. c. 27. a. b. c. d. 28. a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. 29. a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. ARTS ADMINISTRATION Conservation/Restoration Museum Studies Visual Studies ART THERAPY Art Therapy Dance/Movement Therapy Drama Therapy Music Therapy BUSINESS ADMINISTRATION/MANAGEMENT Accounting Business Economics Entrepreneurial Studies Finance Human Resource Management Industrial Administration Insurance International Business Management Information Systems Marketing Organizational Behavior Production/Operations Management Not-for-profit/Non-profit Management Quantitative Analysis Real Estate Taxation Telecommunications Management EDUCATION Elementary, Secondary, and Higher Education Adult/Continuing Education Art/Music/Dance Education Bilingual Education Business Education Curriculum & Instruction Early Childhood Education Educational Administration Educational Measurements/Statistics Educational Philosophy Educational Planning, Policy and Leadership Educational Psychology Foundations of Education Guidance and Counseling Instructional Media/Educational Technology

b. c. d. e. f. g. 46. a. b. c. d. e. f. g. h. i. j. k. l. 47. a. b. c. d. e.

Government Developmental Studies International Law & Organizations International Relations Political Philosophy Political Theory LINGUISTICS & TRANSLATION STUDIES Anthropological Linguistics Applied Linguistics Computational/Mathematical Linguistics Historical/Comparative Linguistics Linguistics Study of Specific Languages Morphology Phonetics/Phonology Semantics Theoretical Linguistics Technical Translation Interpretation Literary Translation & Translation Theory LITERATURE & CREATIVE American Literature Classics Comparative Literature Feminist Literature English Literature WRITING

f. g. 48. a. b. c. d. e. f. g. h. i. j. 49. a. b. c. d. e. f. g. h. i. j. k.

Foreign Literature Pedagogy PHILOSOPHY, RELIGION, AND THEOLOGY Aesthetics Ethics History of Philosophy Logic Metaphysics/Epistemology Philosophy of Languages Philosophy of Religion Philosophy of Science Philosophy of Social Science Social/Political Philosophy PSYCHOLOGY Adolescence & Youth Psychology Applied Psychology Behavioral Psychology Child Psychology Clinical Psychology Community Psychology Comparative Psychology Counseling Psychology Developmental Psychology Educational Psychology Environmental Psychology

l. m. n. o. p. q. r. s. t. u. v. 50. a. b. c. d. e. f. g. h. i. j. k. 51.

Experimental Psychology General Psychology Health Psychology Industrial Psychology Neuropsychology Organizational Psychology Personality Psychology Physiological Psychology Psyometrics School Psychology Social Psychology SOCIOLOGY Comparative Sociology Environmental Sociology History of Sociology Industrial Sociology Medical Sociology Political Sociology Rural Sociology Sociology of Aging/Social Gerontology Sociology of Sex Roles Sociology of Work Urban Sociology OTHER