Competitive College Club Application Form (CCC 2016 EducationUSA Center in Stip)

I. Personal information

Applicant’s first name, surname Applicant’s email address Mailing addressDate of birth:Citizenship:Contact number of an applicant (cell-phone/home) Full name, contact number of applicant’s parent/guardian 1 Email of a parent/guardian 1Full name, contact number of a parent/guardian 2Email of a parent/guardian 1

II. Plans for study in the U.S.Field of studyProgress in application process: Just starting

Choosing/have chosen U.S. universities to which I’d like to apply

Taking/have taken entrance exams(SAT, TOEFL etc)

Will you apply for financial aid offered by U.S universities?

Yes No

Do you have any personal/family funds to cover the cost of your education in the U.S.?

Yes No Some funds, but only for:

Tuition/fees; - housing/foodU.S. Universities: List colleges/universities to which you will apply (if you know already)1.2.3.Do you have relatives in the U.S.? Yes

No Have you ever applied for a U.S. visa? Yes

No

III. School information

Current Educational InstitutionType of institution Public

PrivateCurrent Grade/YearGPA out of 5Graduation dateThe class specialization (check in more than one box if needed)

Mathematics Physics Computer Science Biology Chemistry English language German language World History Geography Arts Other

IV. Educational excellence (add extra fields, if needed)

If your school provides rating of students in the class/among the students of the same grade, please fill in the rating scale (add extra fields, if needed) Rating:Score (scale 1-5) :Subject:Rating:Score (scale 1-5) :Subject:

If participated in any competitions, please fill in the competition participation table (add extra space if needed) Participation in School Competition

Name of competition: Subject: Award: Period:

Interschool (city) competition Name of competition: Subject: Award: Period:

Regional competitionName of competition: Subject: Award: Period:

National competition Name of competition: Subject: Award: Period:

International competition Name of competition: Subject: Award: Period:

V. Academic Honors/Awards/Scholarships/ Exchange Programs

Please list any academic honors, scholarships received, or U.S. government students exchange programs in which you have participated:1.2.3.4.

VI. Extracurricular activities (add extra fields, if needed)

Sports Type of sport: Period:

Musical instruments Type of instrument: Period:

Visual arts Kind of visual arts: Period:

Performing arts Type of performing arts: Period:

VII. Community service (add extra fields if needed)

Type of community service: Institution:Period: Type of community service: Period: Type of community service: Period: VII. The purpose of this exercise is to: a) help you determine and articulate what you believe make you the unique from the other applicantsb) help you identify your areas of interest and strengths so that you are prepared to begin researching undergraduate degree programs

Write a short essay in English answering the questions:

Why are you interested in Competitive College Club? What makes you a good candidate for this club and for U.S. higher education?

Signature

I certify that the information in this form is accurate to the best of my knowledge

Printed Name: Signature Date

____________________________ __________________ _______________________