Open Society Scholarship Programs
Open Society Scholarship Programs
2015CIVIL SOCIETY LEADERSHIP AWARDS
ApplicationDeadline: December 15, 2014
I.Personal Information –Write your name exactly as it is written on your passport. Please write neatly and accurately.
Family Name: ______Given Name: ______
Gender: ______
Date of Birth (MM/DD/YYYY): ______Place of Birth (city / country): ______
Country of permanent legal residence: ______Country/-ies of citizenship:______
Passport Number: ______Country of Issue:______
Date of Expiration (MM/DD/YYYY):______
Have you ever applied for, or do you currently hold, a visa or permanent residency status for any of the participating university countries? If so, describe and give expiration date of visa.
II.Academic Program- Pleaserefer to application guidelines when completing this question.
Field of Study:______
I would like to be considered for placement at the following participating universities:
1.______
2.______
3.______
Are you applying for any other scholarships this year (Open Society Foundations or other) or directly to an academic program? Yes___ No ___
If yes, which ones? ______
III.Current Employer- Include country and city code for phone numbers.
Current position/job title: ______
Place of Employment: ______
Number and Street: ______
City/Region: ______Country: ______
Work phone: (_____) ______Email: ______
IV.Mailing Address - All mail will be sent to this address during application review (until May 2015). Include country and city code for phone number.
Number and Street: ______
City/Region: ______Country: ______
Email: ______Preferred Phone (_____)______
Skype username:______
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V.Permanent Address– If different from mailing address.
Number and Street: ______
City/Region: ______Country: ______
Preferred Phone (_____)______
VI.Professional Experience – List your most recent professional experience first. Please include your full employment history on your Curriculum Vitae and attach it to the application.
Name & Type of Organization(include # of employees) / Job Title & Dates of Employment
(and # of people you supervised) / Job Responsibilities
(and hours worked per week) / Paid or
Volunteer
VII.Education –Starting with your most recent degree, please list theacademic institutions you have attended, including your secondary school.
Institution & Location / Major Field of Study(area of specialization) / Degree / Diploma
(do not translate, write in Latin letters) / Dates of Study
(starting & ending month / year) / Date Degree Received
(or expected)
VIII. Academic Awards - List any awards, grants, fellowships, or honors you have received.
Name of Award / Agency granting award / Year award granted / Location of primary activity / Duration of award/studyIX.Professional, Cultural or Civic Associations - List any professional or other associations to which you belong.
Name of organization / Your role in organization / Year joined association / Year associationfoundedX.Conferences/Workshops/Trainings–List eventsyou have attended that are relevant to your professional interests and proposed field of study. If you gave a presentation, please write the topic in the last column.
Name of Event / Country / Dates / Participant orPresenter? / Presentation Topic
XI.Testing - Please list any standardized test scores you have for graduate study (IELTS, TOEFL, GRE, etc.).
Name of Test / Testing Date / Testing Location / ScoreXII.Language Ability - Rate your reading, writing, listening comprehension and speaking skills for each language you know. Use the ratings of Excellent, Good, Fair, or Poor.
Language / Reading / Writing / Listening / SpeakingXIII. International Experience - Please indicate ALL extensive (more than one month) travel, study, or work you have done outside your home country.
Country Visited / Length of Stay / Dates / Purpose of travelXIV.Required Accommodations - Please identify any disability-related accommodations you require to enable you to participate fully in an academic program. This information will have no bearing on the success of your application.
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____Physically accessible facilities
____Sign language interpretation
Type:
____Materials in Braille
____ Screen reading software
____ Additional time for testing
____ Flexible scheduling
____ Communication Access Realtime Translation (CART)
____ Personal Assistant (please describe in detailbelow)
____Other. Please describe your needs:
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______
______
______
XV.Essays(Please answer all the questions below with a maximum of 250 words for each response):
Why have you chosen your specific field of study?
How would obtaining a graduate degree in this field help support civil society in your home country?
How has your personal experience and family background shaped your professional goals?
How do you define a civil society leader?
XVI.References - Please identify two (2) individuals, one academic and one professional, who will write recommendation letters on your behalf. Please note that the selection committee weighs these letters heavily in evaluating applications.
1. Name: ______Title: ______
Mailing address: ______
______
Telephone number: ______E-mail:______
2. Name: ______Title: ______
Mailing address: ______
______
Telephone number: ______E-mail: ______
XVII. Required Order of Attachments - Please include the following items with your application in the order given below:
- Essay
- Resume or Curriculum Vitae (CV), in English
- Recommendation Letters (if not sent electronically)
- Official university transcripts in original language
- Certified English translation of transcripts
- Photocopy of passport picture page (if available)
Program Administration (optional) -Please note that this information will not influence the outcome of your application; it is strictly for internal program evaluation purposes.
Ethnicity:______Father’s occupation:______
Mother’s occupation:______
Have you previously been admitted into a graduate degree program but did not enroll? Yes____No_____
If Yes, name and location of university:______
Reasons for not attending:______
How did you learn about the Program?
Advising Center
Soros/Open Society Office
Friend / Newspaper/Journal
Listserv ___ (name)
Website ______(name)
Television / Your university
Your workplace
Other ______
XVIII.
Certification and Disclosure - I certify that the information given in this application is complete and accurate. I expressly authorize OSI, the Open Society Foundation in London, any other member of the Open Society Foundations, any participating university, or any third party retained and authorized by such entities to act on their behalf only in the context described herein to use, manage, collect, process, and store my personal data (including “sensitive data” or “sensitive personal data” under applicable law) that I provide to OSI or any other member of the Open Society Foundations in connection with this application, to further their charitable or educational purposes and in particular for the purposes of processing this application and, if successful, arranging my receipt of a Civil Society Leadership Award and my study at a participating university . As part of the process of dealing with my application and arranging my study, my personal data will if necessary be transferred to countries outside of the European Economic Area where there may be a lower standard of protection for personal data, and I consentto such transfer of my personal data.
Name: Signature:
Date:
Submit by December 15, 2014
Late applications will automatically be disqualified. Paper applications submitted by mail must be postmarked by December 15, 2014 and sent to either the New York or London address listed below. Alternately, paper applications may also be sent to one of the country administrative offices:
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Open Society Foundations
Scholarship Programs
224 West 57th Street
New York, NY
10019, USA
Email:
Open Society Foundations
Scholarship Programs
Millbank Tower, 7th Floor
21-24 Millbank, London
SW1P 4QP, UK
Email:
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Local administrative offices- contact address:
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Azerbaijan
Baku Education Information Center
40 J. Jabbarli Street, Caspian Business Center
Baku AZ1065
Tel/Fax: (994 12) 4482845/46
Contact:
Bahar Haji-zada:
Belarus
European Humanities University
Tauro g. 12m LT-10101 Vilnius
LithuaniaTel: 00370 5 274 0622
Contact:
Kevin Reiling:
Turkmenistan + Uzbekistan
Educational Center: "Bilim–Central Asia"
25, Gani Ilyaev Str., Shymkent
160012, Kazakhstan
Tel./Fax (7252) 211981
Contacts:
Larissa Gurbunova:
Arman Turdaliyev:
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THIS FORM IS FREE AND MAY BE DUPLICATED
Open Society Scholarship Programs
2015 Civil Society Leadership Award
Deadline: December 15, 2014
RECOMMENDATION FORM INSTRUCTIONS
Applicants for the Civil Society Leadership Awards are required to submit two recommendations from professors or employers. Your candid, honest responses on the recommendation form provided beloware very important for ourselection process andwill ensure that successful candidates are placed in programs that best fit their academic and professional goals.
Please take the time to provide detailed answers. You may continue answers on additional sheets of paper, if more space is needed.We appreciate your taking the time to assist this applicant.
Recommenders should note the following guidelines:
- Recommendations must be signed and include the name, address, and telephone number of the person providing the recommendation.
- Recommendations written in a language other than English must be accompanied by an English translation. Applicants may not certify their own translations.
- Recommendations from individuals outside academia (employers, etc.) should write or mark “unable to judge” for those questions that relate to purely academic issues.
- Recommendationsmay be completed electronically and submitted to
- If sending via email is not possible, recommendation letters should be returned to the applicant in signed, sealed envelopes in time for the applicant to return them with his/her full application to our offices by program deadline of December 15, 2014.
- Recommendations that are not returned to the applicant should be mailed to the appropriate office at one of the addresses below.
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Open Society Scholarship Programs
224 West 57th Street
New York, NY
10019, USA
Email:
Open Society Foundations
Scholarship Programs
Millbank Tower, 7th Floor
21-24 Millbank, London
SW1P 4QP, UK
Email:
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THIS FORM IS FREE AND MAY BE DUPLICATED
Local administrative offices- contact address:
Azerbaijan
Baku Education Information Center
40 J. Jabbarli Street, Caspian Business Center
Baku AZ1065
Tel/Fax: (994 12) 4482845/46
Contact:
Bahar Haji-zada:
Belarus
European Humanities University
Tauro g. 12m LT-10101 Vilnius
LithuaniaTel: 00370 5 274 0622
Contact:
Kevin Reiling:
Turkmenistan + Uzbekistan
Educational Center: "Bilim–Central Asia"
25, Gani Ilyaev Str., Shymkent
160012, Kazakhstan
Tel./Fax (7252) 211981
Contacts:
Larissa Gurbunova:
Arman Turdaliyev:
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THIS FORM IS FREE AND MAY BE DUPLICATED
Open Society Scholarship Programs
2015 Civil Society Leadership Award
Deadline: December 15, 2014
Applicant’s Personal Information
Family Name / Given NameRecommendation
To be completed by a lecturer, professor, employer, or supervisor who is familiar with the applicant.
Please complete the following form. Your candid, honest response will assist in selecting successful candidates and placing them in programs that best meet their personal and academic requirements.
Your Name and Title (please print):
Academic Affiliation or Place of Employment:
Work Telephone & E-mail:
Signature: Date:
In what capacity and for how long, have you known the applicant?
Please list the courses you have taught the applicant, if applicable.
CourseYear Applicant's Grade
Please comment on the applicant's ability to contribute to the development of their field and civil society in your country.
How do you think the applicant will benefit from a graduate program outside his / her home country?
Overall Evaluation
Compared to other people you have taught or employed, how would you rank the applicant in the following terms? (Circle the best answer.)
Leadership no basis poor average very good excellent
Motivation no basis poor average very good excellent
Creative/Independent thinking no basis poor average very good excellent
Effective communication skills no basis poor average very good excellent
English language skills no basis poor average very good excellent
Respect for others no basis poor average very good excellent
Academic success no basis poor average very good excellent
Overall, how would you rate this applicant?
no basispooraverage very good excellent One of the top
students/employees
I have encountered
If you have completed recommendation forms for other applicants for the Civil Society Leadership Awards, how does this applicant compare to them?
no basispooraverage very good excellent One of the top
students/employees
I have encountered
Please use this space for any additional comments you would like to make about the applicant and add additional pages, if desired.