2012 MEPI Student Leaders: Application Completion Checklist

Candidate Name Name of University Year of Study Field of Study Age Gender Governorate

In order for your application to be complete, please make sure you have: Completed Application Checklist Form (this page) Completed Application (page 3-7) Personal Statement/Essay questions (part of the application form) 1 Recommendation Letter or more (can be from the university or another institution) Updated resume (CV) highlighting civic engagement, leadership and/or work experience, extracurricular activities, and academic honors Copy of official university transcript (please do not submit original transcripts) Copy of National ID and/or passport

Application Instructions:

Applications must be received by January 22, 2012. Late applications will not be considered. Applications can only be submitted by post, or in person as explained below. Applications sent electronically will not be considered. Any applications received after this time will not be considered.
o

Applications must be sent with all required supporting documents by post or hand to the U.S. Embassy in Cairo, Exchanges/Public Affairs Section, 8 Kamal El Din Salah Street, Garden City, Cairo, Egypt. Please write your full name and list the program name on the envelope. Hand delivered applications must be delivered in OPEN envelopes to the Power Checkpoint guard, at the North Gate of the U.S. Embassy, Sunday through Thursday between 11:00 a.m. and 2:00 p.m. (work days only). For postal submission, if you would like to submit your application by mail please send by some type of courier service that is dependable and requires signature upon delivery.

All application must be completed in full in English by the applicant. The application must be type-written; hand-written applications will not be accepted. Incomplete applications will not be considered. All essays should be type-written in English. Essays must be written in the applicants own words and not contain text taken from the Internet, books, or other sources. Applications containing even one sentence of
2012 MEPI Student Leaders p. 1 of 7

plagiarized text will be disqualified automatically. For a definition of plagiarism please visit www.plagiarism.org for guidance on how to avoid plagiarism. Recommendation Letter: We require one or more recommendation letter(s) from someone who knows you well. The recommender can be academic (professor, advisor or teacher), or professional (work/internship supervisor). The recommender must provide the applicant with the letter and it is the applicants responsibility to include as a part of his/her application. Inquiries: Inquiries should be sent by email to CairoMEPI@state.gov or via Facebook group: Study USA-Egypt. Inquiries will be answered within 3 working days.

2012 MEPI Student Leaders p. 2 of 7

 12MiddleEastPartnershipInitiative(MEPI)StudentLeadersInstitutes 20 Application Form

NAME(asitappearsonyournationalIDcard/passport): First: Middlenames: Last: CONTACTINFORMATION MailingAddress Email CellPhone HomePhone WorkPhone

PERSONALDATA Gender DateofBirth (Month,Day,Year) PlaceofBirth (City,Country) Countryofpermanent legalresidence Countryofcitizenship Ifdualcitizen,please indicatenameof country

FIELD OF STUDY Major Minor NameofUniversity Faculty YearofStudy(1st,2nd, 3rdyearorother) LANGUAGE PROFICIENCY NumberofyearsofEnglishStudy WhereStudied Readingproficiency(Excellent,Good,Fair)
2012 MEPI Student Leaders p. 3 of 7

Writingproficiency(Excellent,Good,Fair) Speakingproficiency(Excellent,Good,Fair) PREVIOUS ACADEMIC HONORS/SCHOLARSHIPS Please indicate any scholarships, academic awards, or honors that you have received and the year received:

NON-ACADEMIC/EXTRA CURRICULAR ACTIVITIES Please list community service, internships, professional training, jobs, sports, or cultural activities in which you have participated regularly in the past two years. This includes any service as a team leader, council member, or officer in any institution or activity. Institution Name, City, Country Activity and Your Role Dates of Participation MM/YY MM/YY From: To: From: From: To: To:

TRAVEL EXPERIENCE TO THE UNITED STATES OR OTHER COUNTRIES Please describe any previous travel or study outside of Egypt. Travel Dates MM/YY MM/YY From: From: To: To: Travel Purpose (e.g. vacation, school, etc.) US Government Program? Y/N

RECOMMENDATION CONTACT Identify one individual who can provide you a letter of recommendation. Make sure this individual is familiar with your academic and personal qualities. Name Title MailingAddress TelephoneNumber
2012 MEPI Student Leaders p. 4 of 7

EmailAddress EMERGENCY CONTACT INFORMATION Provide the names and contact information of individuals who should be notified in case of an emergency. In your home country: Name City Telephone Number Relationship to you Street Address E-mail address

FAMILY BACKGROUND Complete the following regarding your family: Fathers Name: Fathers Employment: Employed Retired ___________Year Unemployed

If employed or retired, Occupation: Highest level of education attained: None Number of primary school years_____ Bachelor Degree Number of secondary school years_____ Masters Degree Ph.D.

Secondary Diploma Mothers Name: Mothers Employment:

Employed

Retired ___________Year

Unemployed

If employed or retired, Occupation: Highest level of education attained: None Number of primary school years_____ Bachelor Degree Number of secondary school years_____ Master Degree Ph.D.

Secondary Diploma

How did you hear about the program? Facebook Study US Group U.S. Embassy in Cairo Website Friends MEPI-Students alumni Other, please specify:

2012 MEPI Student Leaders p. 5 of 7

PERSONAL STATEMENT Please answer the following essay questions in the box below. Please write 1,000 words or less.

Name one leader living today that you admire and explain why. What qualities does he or she have that makes him or her an effective leader? How will your participation in the MEPI Student Leaders Program benefit you and others?

2012 MEPI Student Leaders p. 6 of 7

SIGNATURE By my signature, I certify that, to the best of my knowledge, the information provided in my application is accurate and complete, and that I intend to return to my home country upon completion of my MEPI-Students program in the United States. Signature: Date:

2012 MEPI Student Leaders p. 7 of 7