THIS APPLICATION IS FREE OF CHARGE AND MAY BE REPRODUCED WITHOUT PERMISSION

2011-2012 Iraq Science Fellowship Program II Call for Applications

The U.S. Department of State, with its im plementing partner CRDF Global, is pleased to announce the 2011-2012 Iraq Science Fellowship Program II. The Iraq Science Fellowship Program (ISFP) provides the opportunity for highly qualified Iraqi engineers and scientists to spend three to six months working alongside American hosts. During their tenure, fellows will enrich their scientific knowledge and develop project and program management skills. Fellows will return to Iraq with the skills needed to contribute to developing the Iraqi scientific community. ISFP is a public-private partnership supported by private, government, academic, and non-governmental organizations. Up to 18 fellowships will be awarded. Travel, professional development and a monthly stipend will be provided for all fellows. Fellowships placements will be made at U.S. universities, private companies, or other U.S. institutions. Fellows can expect to arrive in the U.S. within the first two quarters of 2012. Individuals seeking acceptance into the program must complete an application. Applications will be screened through a highly competitive process. Acceptance into the ISFP is not a guarantee of placement, which will also depend on the identification of a suitable host and the fellow obtaining a medical clearance and a U.S. visa. To be considered, applicants must currently reside in Iraq. This is an exciting opportunity and we look forward to receiving application submissions. Please circulate this announcement within your professional networks. For email inquiries or to submit your application contact: ISFP@crdf.org.
Applications are due July 8, 2011 17:00 Eastern Standard Time (EST) ISFP results will be announced in autumn of 2011

APPLICATION CHECKLIST Before returning your application, please ensure that you have completed and attached all of the following: Completed Application Form Scanned copy of your current passport Current CV (see sample for type of information that should be included) Letter of Support (LOS) from your current employer (may be submitted after acceptance to ISFP) I. GENERAL INFORMATION
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ISFP does not discriminate in participation on the basis of sex, race, color, age, religion, national origin, or handicap. This policy is consistent with relevant U. S. governmental statutes and regulations

THIS APPLICATION IS FREE OF CHARGE AND MAY BE REPRODUCED WITHOUT PERMISSION

1. Please indicate which field you would like to be considered for (please choose only one): Power Engineering Electrical Engineering Mechanical Engineering Materials Science Computer Science Wireless Technology Solar Energy Renewable Energy Biological Sciences Chemical Sciences

2. Contact Information (as it appears on your passport):

First Name Full Name in Arabic: Home Address:

Second Name

Third Name

Fourth Name Preferred Name:

Tribal Name

(Street, building) Home Telephone Number: E-mail: City and Date of Birth: Mobile Telephone Number: Second Email: Citizenship:

(City)

In case of emergency, whom should we contact? (name, address and telephone number):

3. Passport and Travel Information: Please include a legible scanned copy of your passport with your application Do you have a valid G series passport to enter the U.S.? Series/Number: Country Dates Yes No

Passport Expiration Date: Sponsor Purpose

List previous travel abroad (attach additional pages as needed):

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ISFP does not discriminate in participation on the basis of sex, race, color, age, religion, national origin, or handicap. This policy is consistent with relevant U. S. governmental statutes and regulations

THIS APPLICATION IS FREE OF CHARGE AND MAY BE REPRODUCED WITHOUT PERMISSION

Hobbies and Interests:

Please list any contacts you have in the United States (including family, friends, business associates, and acquaintances):

How did you learn about the ISFP?

Have you previously attended an event sponsored by the U.S. Department of State or received a U.S. Department of State research or travel grant? Yes No Please list event(s):

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ISFP does not discriminate in participation on the basis of sex, race, color, age, religion, national origin, or handicap. This policy is consistent with relevant U. S. governmental statutes and regulations

THIS APPLICATION IS FREE OF CHARGE AND MAY BE REPRODUCED WITHOUT PERMISSION

II. EDUCATION
A. Knowledge of English: Please rate your knowledge of English in the following areas: Excellent Reading Writing Comprehension Speaking List any other languages that you know: Have you ever taken a TOEFL exam? Yes No If yes, please attach a copy of your score. If no, would you be willing to take a TOEFL exam? Yes No B. List all university education, beginning with most recent (attach additional pages as needed): Dates Institute/University Major Subject Degree/Date Received Good Fair Poor

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ISFP does not discriminate in participation on the basis of sex, race, color, age, religion, national origin, or handicap. This policy is consistent with relevant U. S. governmental statutes and regulations

THIS APPLICATION IS FREE OF CHARGE AND MAY BE REPRODUCED WITHOUT PERMISSION

III. EMPLOYMENT EXPERIENCE

1. Employment Information:

Current Place of employment:

(Complete Ministry/University/Company Name) If a company, please describe the type of business (consulting, private company, scientific institute, higher education institution, government, etc):

Position/Title: Do you have the support of your employer to participate in the ISFP? Yes No If yes please include a letter of support from your employer with your application that states that they will continue to pay your salary for the duration of the ISFP, and that you will be able to return to your job at the end of the ISFP. A. List your business and employment history, beginning with most recent: Dates Name of Organization City Position/Title Responsibilities and duties

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ISFP does not discriminate in participation on the basis of sex, race, color, age, religion, national origin, or handicap. This policy is consistent with relevant U. S. governmental statutes and regulations

THIS APPLICATION IS FREE OF CHARGE AND MAY BE REPRODUCED WITHOUT PERMISSION

B. Please list your current supervisor and two other professional /ministry/university references (name, email and phone number -- REQUIRED) Name Company Name, Email address, and Telephone Number (include country/city code) Relationship

1. 2. 3.

IV. STATEMENT OF PURPOSE

On separate sheets of paper, please answer the following questions. The answers you provide should be no more than 2 pages in total length and should be in English: 1. Describe the organization you currently work for and your specific responsibilities in the organization. This must include: your title; the name of the division or department for which you work and its major function within the organization; how many employees report to you directly; some of the major problems you have encountered in your work and how you think this program might assist you with those problems; and any other information you think would be of interest.

2.

Describe how your experience and expertise can be used to aid in the reconstruction of Iraq.

3.

If selected for the Iraq Science Fellowship Program, what type of institution would you like to be placed at (University/Company) and in what section or department?

4.

In the Iraq Science Fellowship Program, participants help create their own goals what type of goals would you set for yourself that would help in designing a well matched program for you in the U.S.?

5.

Please describe how you think your sk ills and k nowledge would contribute to the U.S. organization you will work for during your fellowship.

6.

How would you plan to apply the knowledge you will gain as a participant in the Iraq Science Fellowship Program to your work in Iraq -- both in your organization and the country as a whole?

7.

What makes you a good candidate for the Iraq Science Fellowship Program (limit to one paragraph)?

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ISFP does not discriminate in participation on the basis of sex, race, color, age, religion, national origin, or handicap. This policy is consistent with relevant U. S. governmental statutes and regulations

THIS APPLICATION IS FREE OF CHARGE AND MAY BE REPRODUCED WITHOUT PERMISSION

CERTIFICATION: IT IS VERY IMPORTANT THAT ALL APPLICANTS READ THIS SECTION AND UNDERSTAND THE TERMS OF THIS FELLOWSHIP. I testify that the information submitted in this application is complete and accurate. I understand that providing false infor mation on this application or during the interview may disqualify me from participation in the Iraq Science Fellowship Program(ISFP), or if Iam selected, dismissal from the ISFP. If selected, I agree to com with all regulations of the ISFP and all local and national laws of th United States ply e (U.S.). Regulations of the ISFP include, but are not lim ited to: housing agreements, participant agreement form, banking and s tipend agreements, and regulations of the host institution. All applicants accepted into the ISFP will receive the following support from CRDF Global: 1. Round-trip, economy-class airfare from Iraq to the U.S. 2. Lodging within reasonable proximity of the U.S. host institution. 3. Monthly stipend for living expenses, including ground transportation 4. Emergency Medical Insurance during the ISFP By participating in the ISFP: I understand and acknowledge that CRDF Global support is limited to the financial transactions itemized above and is contingent upon my successful participation in the ISFP. I understand that if I do not complete the ISFP I will be required to return a pro-rated stipend amount to CRDF Global and may be required to reimburse CRDF Global for any additional travel expenses incurred as a result of my early departure. I understand and acknowledge that CRDF Global will obtain lodging on my behalf and will make payment directly to the provider, however I am responsible for ensuring the proper use and care of any lodging facilitates. I understand that I may be considered personally liable for any damages that occur at my lodging facilities. I understand and acknowledge that CRDF Global will obtain emergency medical insurance on my behalf and will make payment directly to the provider, however this insurance is to be utilized only for emergency situations and not for routine medical care or treatment, including for any pre-existing medical or dental condition. I further understand that I may be required to pay all deductibles and other health-related expenses not covered by the insurance. I understand and acknowledge that I am responsible for complying with all relevant U.S. laws and regulations during the term of the ISFP. I understand and acknowledge that the U.S. visa obtained in connection with the ISFP is valid only for temporary professional education and is not valid for employment in the U.S. I understand that returning to Iraq at the end of my internship is a mandatory condition of my participation in the ISFP and I declare my intent to comply. I understand that any travel to cities in the U.S., ISFP related or otherwise, as well as travel outside the U.S., is subject to the approval of CRDF Global and the U.S. Department of State. Any travel taken without the approval and notification of CRDF Global and the U.S. Department of State would be a violation of my U.S. visa and could result in my immediate dismissal from the ISFP. I understand the ISFP prohibits immediate family from accompanying ISFP participants to the United States and from traveling to the United States during the participants ISFP term. I understand that a violation of this policy could result in my immediate dismissal from the ISFP. I understand that neither CRDF Global, nor the U.S. Department of State, has any liability to me for any loss, damage or injury incurred in the course of or in connection with the ISFP, and that any claims will be limited to the level of insurance coverage provided by CRDF Global.

(Signature)

(Date)

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ISFP does not discriminate in participation on the basis of sex, race, color, age, religion, national origin, or handicap. This policy is consistent with relevant U. S. governmental statutes and regulations