For secondary school educators

APPLICATION FOR THE 2022 STUDY OF THE UNITED STATES INSTITUTES (SUSI)

FOR SECONDARY SCHOOL EDUCATORS

A. Full Name (exactly as it appears on passport)

Last Name: Mukhtarova

First Name: Sayyora Khan

Middle Name: Ganijonovna

B. Date of Birth (mm/dd/yyyy): 01/08/1979

C. Birth City: Andijan

D. Birth Country: Uzbekistan

E. Citizenship: uzbek

F. Residency: 111-house,Iste’dod-5 street,Andijan district

G. Medical, Physical, Dietary or other Personal Considerations:

Please describe any pre-existing medical conditions, including any prescription medication you may be taking, allergies, or other dietary or personal consideration. This will not affect the selection, but will enable the host institution to make necessary accommodations.

I have no problem that mentioned above