Date of Birth (DD/MM/YY): __________________________________________________________________
City and country of birth: ____________________________________________________________________
Home address: _____________________________________________________________________________
E-mail: _____________________________________ Telephone number: _________________________________________________________________________
School number/name: _______________________________________________________________________
Year of study/Grade: _________________________________________________________________________
If available, TOEFL/IELTS score from within past 6 months:__________________________________________
If available, estimate of English proficiency on CEFR scale: ___________________________________________
2020 Host Institutions and Program Dates:
*Please note that we will attempt to accommodate placement requests. However, we cannot guarantee placement at particular host institutions.
Personal Essay: Please provide a statement of interest (500 words or less) answering the question “Why do you want to participate in EducationUSA Academy and what do you hope to gain from the experience?” You may type the essay in the space below or attach it in a separate document.
Please email completed application form to Tashkent-Advising@state.gov by February 20, 2020.