Study of the U.S.

Institutes for Student Leaders Program

FY 2018 Application Form

A. Current Academic Institution and City Name

Institution and City Name:

B. Candidates Full Name, exactly as it appears on passport

Prefix:
Last Name:
First Name:

C. Gender
Male:
Female:
D. Date of Birth (please spell out Month, Day, Year)

E. City of Birth:
F. Country of Birth:
G. Citizenship:
Primary:
Secondary, if applicable:
H. Country of Residence:

I. Medical, Physical, Dietary or other Personal Considerations

J. Contact information
Address:
City:
Home State or Province:
Home Country :
Residence Phone no:
Mobile No:
Email:

K. Emergency Contact
Name and Relationship:
Phone number:
 E.mail address:

L. About Family

Parent or Name Occupation

Guardian
Father
Mother

Address (if different from yours):

Telephone:
Email:

Brothers/Sisters

Name Gender Age Occupation

M. Education
Current
Education, Academic and Professional Training, including degree earned and fields of
specialization
 Degree Year in Specialization/ City Expected Grade/GPA
School Institution Graduation
Date

Previous

N.
Degree Earned Year Earned Specialization/ Institution City Grade/GPA Sc

hol

ars

hip

Are you currently on or have you ever earned any kind of scholarship (if yes, please provide
details) :

O. Work and Volunteer Experience:

P. Memberships in Associations, Clubs, etc:

Q. Previous experience in the United States: Please list any and all trips the candidate has made to
the United States and include approximate dates and the reason for travel.
Purpose Travel Dates State/City Description


R. Previous experience in any other county abroad: Please list any and all trips the candidate has
made to any contry outside Pakistan and include approximate dates and the reason for travel.
Purpose Travel Dates State/City Description

S. Family Residing in the United States: Please list any immediate family members (parents and
siblings if unmarried/spouse and children if married) who are currently residing in the United
States, including city and state.
Name Relationship State/City Occupation

T. Personal Statement (Please structure your essay in paragraphs and limit your response to 250 words,
single-spaced. Essays that exceed the word limit are penalized in the scoring.)
Tell us about yourself and your goals including the following:
What about you background and/or interests make you competitive for this particular
institute (please be as specific as possible)?
What will you contribute to the group?
How do you expect this experience will affect your future academic and professional career?

U. Short answer questions
The short answer questions are an essential part of the selection process. Please structure your response
using paragraphs and limit your response to 150-250 words.

1) What would be the one initiative you would like to see started at the local neighborhood or
regional/provincial level in Pakistan? What different people or groups need to participate to make
an effective local or regional/provincial program?

2) Why are you interested in the specific theme of local, state, and federal public policymaking?