APPLICANTNAME:__RUQIYA_______________________

CITY/PROVINCE:___KHAIRPUR MIR’S,SINDH________________________

Teaching Excellence and Achievement

Program (TEA) for Pakistan
A program of the United States Embassy in Islamabad’s Public Affairs Section (PAS),
implementedby IREX and Evolution

Applicationfor Pakistani Secondary-Level English Teachers

The United States Embassy’s Public Affairs Section, IREX,and Evolution announce an open competition for a
programthat will bring outstandingsecondary school teachers of English from Pakistan to the United States for a six-
week professional development program. The TEAProgram for Pakistan seeks to further develop teachers’ expertise
in their subject areas, enhance their teaching skills and Englishproficiency, and increase their knowledge about the
United States.

ONLY SECONDARY-LEVEL ENGLISH TEACHERS ARE ELIGIBLE TO APPLY

Please return completed application (printed/hard copy) to:

Evolution Office,
C-26-5/II, Al-Murtaza Commercial Lane # 3, Phase VIII, DHA, Karachi 75500

DEADLINE:

JANUARY 30, 2017

For more information go to:

www.evolution.com.pk/TEA

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

Teaching Excellence and Achievement Program (TEA) for Pakistan

Application for Pakistani Teachers

PROGRAM OVERVIEW
TheTeaching Excellence and Achievement (TEA) Program for Pakistan will invest in teacher professional development
by bringing outstanding secondary school teachers of English from Pakistan to the United States to further develop
expertise in their subject areas, enhance their teaching skills and English proficiency, and increase their knowledge
about the United States. Twenty teachers will be brought to the U.S. on a six-week professional exchange program.
Upon return to Pakistan, alumni will be included in IREX’s ongoing programming for TEA Program for Pakistan alumni,
including eligibility for small grants.

ABOUT IREX
IREX is an international nonprofit organization providing thought leadership and innovative programs to promote positive
lasting change globally. Our mission is to build a more just, prosperous, and inclusive world by empowering youth,
cultivating leaders, strengthening institutions, and extending access to quality education and information.

Foundedin1968,IREXhasanannualportfolioofover$70millionandastaffofover400professionalsworldwide.IREXemploys
field-testedmethodsandinnovativeusesoftechnologiestodeveloppracticalandlocally-
drivensolutionswithourpartnersinmorethan100countries.

ABOUT EVOLUTION
Evolution is a registered educational training organization based in Pakistan that promotes community, youth and
professional empowerment through various capacity building and training programs at personal, organizational and
societal levels. We pledge to offer the highest quality of services, the optimum level of expertise and assiduous
dedication to train Pakistani youth and professionals with integrity and honor through a wide range of training programs
endorsing leadership skills, team building, computer literacy, gender equality and women empowerment.

ELIGIBILITY REQUIREMENTS
Applicants must:
 Be currently working full-time as a secondary-level English teacherin a government or foundation school that
serves a primarily local (not expatriate) population (teaching classes 6 to 10);
 Have at leastfive years of classroom experience in English language teaching;
 Be citizens and current residents of Pakistan;
 Hold at least a Bachelors degree;
 Be proficient in written and spoken English;
 Demonstrate a commitment to continue teaching for at least five years after completion of the program; and
 Have submitted a complete application.

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

PLEASE NOTE: ADDITIONAL ELIGIBILITY INFORMATION

If you have participated in other U.S. Department of State funded programs, please write to Evolution on
tea@evolution.com.pk to know about your eligibility.

Staff or families of staff at a U.S. Post or Fulbright Commission or the TEA Program for Pakistan in-country
implementer are not eligible to apply.

TEA Program for Pakistan is aprogram for practicing teachers. Ministry of Education and Trainingofficials, full-time
principals, educational administrators, full-time teacher trainers, university faculty and private English Language tutors
are NOT eligible.

IREX does not discriminate against applicants because of race, color, religion, sex, age, national origin, disability or
any other protected characteristic as established by U.S. law.IREX has successfully hosted participants with
disabilities in the past. Applicants with disabilities will be considered equally eligible.

Please note that applicants will need appropriate permissions from their school management, such as No
Objection Certificate (NOC) issued by the competent authorities, in order to undertake international travel if
selected for the program. Although this is not required at this stage with application, however, this will be an
essential requirement if selected for the program.

APPLICATIONS NOT MEETING ALL OF THE ABOVE ELIGIBILITY REQUIREMENTS WILL NOT BE FORWARDED TO THE SELECTION
COMMITTEE. IREX AND EVOLUTIONRESERVETHE RIGHT TO VERIFY ALL OF THE INFORMATION INCLUDED IN THE APPLICATION.
IN THE EVENT THAT THERE IS A DISCREPANCY, OR INFORMATION IS FOUND TO BE FALSE, THE APPLICATION WILL IMMEDIATELY
BE DECLARED INVALID AND THE APPLICANT INELIGIBLE.

PROVISIONS OF THE FELLOWSHIP

 J-1 visa support;

 A pre-departure orientation held in Pakistan;
 Round-trip airfare to and within the U.S.;
 A Welcome Workshop or Program in Washington, D.C.;
 Academic program fees;
 Housing (shared with other program Fellows of the same gender) and meals;
 Accident and sickness medical coverage (does not cover pre-existing conditions);
 Transportation to the practicum school (if necessary);
 A daily allowance for incidentals during the university academic program;
 A book/professional development allowance;
 A baggage/shipping allowance;
 A Closing Workshop in Washington, D.C.; and
 A re-entry seminar in Pakistan
 The opportunity to apply for alumni small grants.

SELECTION PROCESS AND CRITERIA

TEAProgram for Pakistan Fellows will be selected through a merit-based, open competition-based on the criteria
below. Top candidates will be interviewed by an interview panel and must take the TOEFL (Test of English as a
Foreign Language) or equivalent English language examination or provide valid English test results from within a year
of the program start date. Evolution will administer logistics for shortlisted participants to take TOEFL in their

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

respective regions.

Selection Criteria (not in order of importance):

 Demonstrated commitment to teaching in the field of secondary education

 Demonstrated leadership potential;
 Professional and educational experience and achievements;
 Potential for developing long-term linkages between U.S. and Pakistani educational institutions and schools;
 Preparedness (including maturity, flexibility, and ability to function independently) for an intensive U.S.-based
training program with limited free time for personal travel or sightseeing;
 Willingness and capacity to work and live collaboratively with peers to foster a positive learning community for
professional development;
 Ability to express ideas clearly and effectively; and
 English language skills adequate to manage coursework, develop lesson plans, and team-teach in U.S. schools.
 Applicants who have had few or no opportunities to travel to the U.S.will be givenpriority.
 Applicants from rural, under-resourced schools who have had limited or no previous professional development
opportunities inPakistan or the U.S. will be givenpriority.

GENERAL APPLICATION INSTRUCTIONS & SUBMISSION GUIDELINES

 Please answer all questions on the application.
 Please type or print in blue or black ink.
 If a question does not apply to you, enter N/A (not applicable).
 Include your full, legal name as spelled on your passport (if available) or other photo identification.
 Include complete contact information (including zip/postal codes for alladdresses and city codes for all phone and
fax numbers if available).
 Write your full name, city, and province in the top right corner of each page.
 Hand-sign the Privacy Policy and Application Certification Statement on the last pageinink.

INSTITUTIONAL SUPPORT AND REFERENCE FORM

All applicants must include the Institutional Support and Reference Form, which must be completed by theirsupervisor
at the school at whichthey are employed and signed by their school director/principal. The form must be hand-signed
in ink. An English translation must be provided if the form and reference letter are not written in English.

A COMPLETED APPLICATION INCLUDES ALL ELEMENTS LISTED BELOW:

1. Completedapplication with photocopy of academic transcripts
2. Hand signed Privacy Policy and Application Certification Statement page;
3. Institutional Support and Reference Form completed by your supervisor and signed by your school director/principal;
and
4. A clear copy of the first two pages of your passport (or photo identification)

PROGRAM TIMELINE

30thJanuary 2017 ApplicationDeadline

February–April 2017 TOEFLTesting/Interviews

May 2017 NotificationofFinalists

August 2017 Pre-DepartureOrientation

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

September – October 2017 U.S.ProgramDates

Teaching Excellence and Achievement

Program (TEA) for Pakistan
A program of the United States Embassy in Islamabad’s Public Affairs Section (PAS), implemented
by IREX and Evolution
Application for Pakistani Secondary-Level English Teachers
Please complete ALL information requested. Incomplete applications will not be reviewed.
Name(please spellexactly asitiswritten inyourpassport)
RUQIYA
First/Given name:
N/A
Middle name:
RID
Familyname/Surname:
Country
PAKISTAN
CountryofCitizenship:
PAKISTAN
CountryofLegal Residence:
Place of Birth
KHAIRPUR
CityofBirth:
PAKISTAN
CountryofBirth:
Gender

□Male□Female
Number of YearsTeaching
15
Ihave beenteaching for years(notincludingstudent teachingpracticums).

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

Date of Birth(aslistedonyour passport)

Month: APRIL Day: 12 Year: 1977

Please check yourbirthmonth:

□ January □February □March □April □ May □June

□ July □August □September □October □November □December

Whatclasses doyouteach?(check allthat apply)

English

□ English fornativespeakers □Englishfornon-nativespeakers □Englishliterature

□ English Grammar □Other

9.Home Mailing Address:

House/Apartment Number: _HOUSE NO. 33_____________________________________________

Street/Building Name and/or Number: MADINA COLONY NEAR FOOD OFFICE , P.O KTM KHAIRPUR MIR’S

City or Town: KHAIRPUR Postal Index/Number: N/A

Country: PAKISTAN Region/Province: SINDH

(if applicable)

Telephone number: +92342 3010148 Mobile Telephone: +92300 2449851

(country code + city code + number) (country code + city code + number)

E-mail: ruqiyarid@gmail.com _________________________________

10. School Address (current job):

Name of School: GOVT BOYS HIGH SCHOOL TANDO NAZAR ALI

City or Town: KHAIRPUR Region/Province: SINDH

Country: PAKISTAN

11. School Information:

(a) Is your school in an urban or rural area? □Urban □Rural

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

(b) Is your school a government-run or foundation school? □Government-run □Private

Total number of students at the school: 636
Total number of full-time teachers at the school: 13
Total number of part-time teachers at the school: N/A
Grade levels at the school: 1 TO 10 CLASS
Age range of students: 5 TO 15 YEARS
Average number of students per class: 70 STUDENTS

In less than 200 words, please tell us briefly about your school and the community it serves: Who are the students?
What do they do when they leave school or complete their studies at your school? What kind of work do their parents
do? Please briefly share any other important information about the school community.

I am working as an english teacher in Goverment Boys High School Tando Nazar Ali Khairpur. It is situated at Tando
Nazar Ali Village. I am the residence of Khairpur City.Therefore when I compare this village with the city, I find it very
poor and undeveloped village. It has no facility except the electricity which is also by name. Here most of the people
are uneducated and jobless.Most of them are drugaddicts. They are unaware of the importance of education especially
girls’ education as it is a co education school so very few parents allow their daughters to study at school.
The students who study at our school are mentally intelligent but as they live in an uneducated
environment so they don’t know how to study.Apart from that their base is not good therfore they face difficulty to learn
in senior classes.Those students who studied at our school and completed their studies are now doctors ,
engineers,teachers,policeman and peons etc.Sadly most of the educated villagers have left their village and live in city
now . Not only they have left the village more over they didn’t do anything for the welfare of their villagers.We are
thirteen teachers here.Only two of the thirteen are local.While others are from the city. Though the village is not very
far from the city even it is in very poor condition.

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

12.Have you ever been arrested or convicted of a crime?

□Yes □No
If yes, please provide additional information, including a description of the factual circumstances of the arrest or
conviction and any supporting documentation.

N/A

13.Has a teacher at your school participated in the TEAProgram for Pakistan? If yes, what is his/her name?

□Yes □No
Name(s):_____N/A__________________________________________________________________

14. Are you currently applying to any other U.S. government sponsored program, including online programs?
□Yes □No
If yes, please specify which program: N/A
Program Dates: _______________________ N/A __________________________________________
Name of sponsoring organization: N/A

15. Are you currentlyapplying or do you plan to apply to any professional development programs in other
countries?□Yes □No

If yes, please specify which program: N/A

Program Dates: __________________________ N/A _______________________________________
Name of sponsoring organization: N/A

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

16.
Inthechartbelow,pleasefillinanyprevioustripsyouhavetakenoutsideofPakistan.Pleaseincludetripsfortourism,work,a
ndexchangeprograms.AlsoincludeanytripssponsoredbytheU.S.government.Pleaseprovideasmanydetailsaspossi
bleinthe“Notes”column.

ReasonforVisit(Work/T Notes
City,CountryVisited YearofTravel ourism/
ExchangeProgram) (Nameofprogram,programdetails,sp
onsoringorganization,etc.)

N.A

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

17. Please list other international exposure you have had including working with international organizations or
foreigners in Pakistan.

N.A

18. During the TEA Program for Pakistan, participants will have roommates with different backgrounds and
experiences. What steps would you take to successfully live with this person?Give an example of a time you had to
demonstrate flexibility interacting with someone with customs or values that differed from your own.

I am social by nature.I enjoy with different types of people . I respect others feelings and values.Therefore I don’t have
any problem with them .

19. How did you hear about the TEAProgram for PakistanProgram?

□Colleague □Program Alumnus □Friend □School Administrator□U.S. Embassy

□Publication: □Website:
□Other:

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

20. Education: Please list your educational background.

# of Year
Institution/School years of Field of Study Degree/Certificate Degree
(BA, BS, MA, MS, PhD, etc.)
study Earned
G,Degree College pir jo 1997 Science B.Sc 1998
Goth
Shah Abdul Latif 2000 English M.A 2001
University Khairpur
Shah Abdul Latif 2003 Education M.Ed 2004
University Khairpur

21. Foreign Language Proficiency: Please rate your proficiency for each language you know in the categories of
reading, writing, comprehension and speaking. Please rate as Beginner, Intermediate, Advanced, or Fluent.

Reading Writing Comprehension Speaking

English Fluent Advanced Advanced Intermediate

22. Work History: Please list below your work history for the past five years. Please list your currentposition first.
You should complete only one section per school, even for multiple years.
Current School Information
Name of school: Govt Boys High School Tando Nazar Ali Khairpur
Type of School:Position/Title: High School
Length of employment (dates): 3 Years
Grade level(s) taught and age range of students: IX and X Classes, 14-15 Years
Number of hours per week teaching: 13 Hours and 20 minutes
Title of classes taught: English and Sindhi
Additional duties: co-ordinator and Incharge of co curricular Activities
Previous School Information
Name of school: IBA Cummunity College Khairpur
Type of School:Position/Title: School and College
Length of employment (dates): 1 Year
Grade level(s) taught and age range of students: III to VIII Classes, 8 to 13 Years
Number of hours per week teaching: 14 Hours
Title of classes taught: English, Social Studies and Islamiyat

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

Additional duties: Co-ordinator of Junior Section and Assembly Incharge

Previous School Information

Name of school: Bahria Foundation College Khairpur
Type of School:Position/Title: School and College
Length of employment (dates): 8 Years
Grade level(s) taught and age range of students: VI to X, 11 to 15 Years
Number of hours per week teaching: 17 Hours
Title of classes taught: English, Science and Social Studoes
Additional duties: Incharge of cocurricular Activities

23. AdditionalEducationorProfessionalExperience&Activities:Pleaselistwhatactivities
youhavepursuedinsideandoutsidetheclassroomtomaintainyourprofessionaltrainingasaneducator.Inaddition
,pleaselistprofessionalorganizationsthatyouareamemberofandrelevantworkinyourcommunityoutsideofscho
ol.
I try my best to make my teaching more enjoyable to students, Whatever I teach I try to make it easy to understand
and avoid to make it burdon for the students. I encourage the students to take part in extra curricular activities.

24. Describe how you engage with/address the needs of underserved, at-risk/marginalized youth in your
school/community.

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 APPLICANTNAME:__RUQIYA_______________________

CITY/PROVINCE:___KHAIRPUR MIR’S,SINDH________________________

25. Weekly Schedule:

Number of
Day of the Length of Class/Responsibility (in Grade Age of
School Name Time of Day Subject Students in
Week minutes) Level Students
the Class
Sample Schedule Monday 9:00 – 9:45 am 45 minutes/ Teacher Geography Level 9 55 students 14 – 15 years
Sample Schedule Monday 10:00 – 10:55 am 55 minutes/ Teacher Civics Level 10 55 students 16 – 17 years
Sample Schedule Monday 1:00 – 1:45 pm 45 minutes/Teacher History Level 10 55 students 16 – 17 years
Sample Schedule Monday 2:00 – 3:00 pm 60 minutes/ grading Prep
Sample Schedule Tuesday 8:30 – 9:25 am 55 minutes/ Teacher Civics Level 10 55 students 16 – 17 years

Please provide a sample of your weekly schedule. List all classes you are currently teaching, including planning and preparation time, as well as
additional responsibilities outside of teaching. If you teach in more than one school, please indicate the school name. A sample is provided above.

Your Schedule:
Length of class/
Grade Number of Students Age of
School Name Day of the Week Time of Day responsibility Subject
Level in the Class Students
(in minutes)
GBHS Tando Monday 8.50- 40 minutes English X 68 15 years
Nazar Ali 9.30am
10.10- 40 minutes Urdu X 68 15years
10.50 am
12.30- 30 minutes Urdu X 68 15years
1.00pm
Tuesday 8.50- 40 minutes English X 68 15years
9.30am
10.10- 40 minutes Urdu X 68 15years
10.50 am
12.00 - 30 minutes English IX 76 14 years
12.30pm
12.30- 30 minutes English X 68 15years
1.00pm
Wednesday 8.50- 40minutes English X 68 15years
9.30am
10.00- 40minutes Urdu X 68 15years
10.50am
12.00- 30minutes English IX 76 14years
12.30pm

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

12.30- 30minutes Urdu X 68 15years

1.00pm
Thursday 8.50- 40minutes English X 68 15years
9.30am
10.10- 40minutes Urdu X 68 15years
10.50 am

25 cont. Weekly Schedule:(additional space if needed):

Length of class/
Time of Number of Students Age of
School Name Day of the Week responsibility Subject Grade
Day in the Class Students
(in minutes)
GBHS Tando Thursday 12.00- 30minutes English IX 76 14years
Nazar Ali 12.30pm
12.30- 30minutes English X 68 15years
1.00pm
Friday 8.50- 40mi.nutes English X 68 15years
9.30am
11.55- 35minutes Urdu X 68 15ears
12.30pm
Saturday 8.50- 40minutes English X 68 15years
9.30am
11.30- 30minutes English IX 76 14years
12.00pm
12.00- 30minutes English X 68 15years
12.30pm
1.30- 30minutes Urdu X 68 15years
2.00pm

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

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 APPLICANTNAME:__RUQIYA_______________________

CITY/PROVINCE:___KHAIRPUR MIR’S,SINDH________________________

26. Statement of Purpose: Your Statement of Purpose is the most important part of your application. Your response
will give the selection committee an opportunity to better understand you as a teacher leader and your reasons
forparticipating in the program. Statements must be clearly written in order to be considered.

In the space provided, please address all questionsin no more than 500 words:

 WhydoyouwanttoparticipateintheTEA Program for Pakistan and what skills and experience do you hope to
gain from the program?

 Identify a challenge or pressing issue you seek to address in your school or community upon returning home
from the TEA Program for Pakistan. How will participation in the program help you achieve these goals?What
will you focus on during the program?

I want to participate in TEA program, the first reason of it is that I love to learn,to learn from everyone
and from everywhere. I never want to lose any chance to learn even if it is very little to learn. I allways
thirsty to learn I am not only fond of learning but I am also keenly interested in teaching. Because I think
learning without teaching is useless. If one has lot of knowledge or some skills but no one has got any
advantage of it. Then obviosly one would not has any fruit in return of it. Knowledge and skill are the two
main weapons to win the battle of life. I am expecting the TEA program to enhance my knowledge and
skill . And will make me more useful for my students as well as for my profession. I am professional by
heart, and strongly passionate for my job. Because our job gives us great honour and earning to live. I
am very proud of my job as it makes me to earn with honour. Not only this but it gives me very sacred
thoughts about myself.
The second reason is my love for travelling. I think travelling is also the main source of learning. As
famous scholars, poets and writers of the world travelled a lot and they learnt from their travels.
The third reason is that I have heard that the developed countries have better methodology of teaching
than us. So I want to observe their way of teaching. It will be great opportunity for me to get such
experience with the help of TEA program.

As our school is in remote area. Here students and their parents are unaware of the importance of
education. Therefore it is hard to motivate them to give their energy for studies. Moreover it is difficult to
make our students regular and punctual. I want to learn to motivate the students as well as the
community to get the education with zeal and zest. I hope this TEA program will help me to acheive my
goal.

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

Additional Space: Please use this space for any additional information.Include any responses that did not fit
elsewhere in the application.

As I am the only one female teacher at my school. Therefore I have been given the responsibility to supervise the girls
as well as the boys. I try my best to build their character building. Because I think highly educated is the one who is
highly mannered. Being a teacher it is my duty to educate them moreover to train them for their bright future.

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

IREX PRIVACY POLICY & APPLICATION CERTIFICATION STATEMENT

Your privacy is important to IREX. That is why we request that all applicants read the following privacy policy
statement carefully.

1. APPLICANT AND PARTICIPANT INFORMATION CONTENT AND STORAGE

Information about program applicants, current and past participants consists of data contained in their applications,
information derived from interviews, and information gathered during the course of their program and as program
alumni. IREX stores this information in written and electronic form indefinitely. Some data, such as contact information
and professional experience, is continually updated.

2. USE OF INFORMATION: Information, which is described above, may be:

A. Used by selection committees and interviewers to review applicants;
B. Supplied to the program’s funding organization;
C. Submitted to potential host schools, universities, or organizations and/or organizations that provide practicum
opportunities; and
D. Used for the evaluation of an individual’s participation in the program and in the collection of data for general
program evaluation by IREX, funding agencies or other organizations contracted to conduct evaluations.
IREX does not sell applicant or current/past participant information.
The principles stated herein are binding only to IREX; other organizations involved in the implementation of these
programs may adhere to other privacy or similar policies.

3. CERTIFICATION: I certify that I completed this application myself, without any aid or assistance, that the information
given in this application is complete and accurate, and that I have carefully read and understand all notes and
disclaimers provided therein.
I understand that IREX reserves the right to verify all the information listed in the application. I understand that giving
false or misleading information in the application will result in exclusion from the competition or immediate dismissal

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 APPLICANTNAME: _____RUQIYA_____________________

CITY/PROVINCE:________KHAIRPUR MIR’S ,SINDH___________________

from the Teaching Excellence Achievement (TEA)Program for Pakistan.

Also, I acknowledge that I am aware of the following requirements that I must observe if I am selected for the program:

 I must abide by all program rules and regulationsand observe all the laws of the United States during my stay
there, including returning to Pakistan for at least two years at the conclusion of the program in compliance with
J-1 visa requirements.
 The medical coverageprovided to me during my travels is intended only for emergencies and does not cover
ordinary, pre-existing, and routine dental conditions.
 My spouse, children, other relatives or individuals are not permitted to accompany me to the United States on
the program.

Signature of Applicant (must be hand signed) Date

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