Application Form
(Please, read info on page 5 before you fill and submit this form.)
A. Personal Information.
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PHOTO
Attach a recent photograph of yourself taken during the last year
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First name, second name and family name
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Prefer to be called
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- Male
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- Female
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Date of Birth (e.g. September 2nd, 1995)
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Sex
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Place of Birth (town/city)
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Country of Birth
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Full Home Address (Street, No., block, etc.)
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City/Town
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Postal Code
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Phone (Home and/or Mobile) (country code, city code, number
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Fax Number
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E-mail
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Country of Citizenship
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Nationality
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B. Education.
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Full Name of School you Attend (in English) (+ city/town)
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Full Name of School you Attend (in Bulgarian) (+ city/town)
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Name of Head/Principal
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Type of School
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- Public School
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- Private School
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- Gymnasium
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- General
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- Classical
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- Science
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- Bilingual*
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- Vocational School
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*If Bilingual, please provide in what language/s.
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In what year you will finish secondary education?
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D. Languages.
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Language
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How many years?
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Hours per week
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School or Private Course?
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Grades/scores
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English
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Of these, which do you plan to study in the USA/UK?
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E. Academic, Extracurricular And Personal Interests.
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List the academic subjects that interest you the most; honors/awards won in the last 3 years, if any:
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List the current sports (athletic activities) that you play and for how long (Note team, position, honors won, if any):
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List the current performing and visual art forms that interest you the most and in which you participate. (Note any instrument you play; choir/band/orchestra to which you belong; dance/ theatre group; painting, drawing, photography, etc. and for how long).Please note any awards you have won during the last three years.
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List the clubs, organizations or community service groups to which you belong. (Note how long you have been involved, the purpose of the group, and your role in it.)
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What field of study or future occupation are you considering?
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Have you spent more than one month in a western country? If yes, where, when and how long?
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What 3 adjectives would you choose to describe yourself?
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F. Country/Program Preference.
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We ask that you check the box to the left of each program for which you wish to be considered. Please also rank your choices (e.g.1st, 2nd, 3rd) to the right so that we know your preferences. This helps the interviewers a great deal and does not influence your selection for a scholarship.
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Programs
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Preferences
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ASSIST, USA, Full scholarship
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HMC, UK, Full scholarship
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Davis Program, USA
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No Preference
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ASSIST, USA,
Partial scholarship
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HMC, UK,
Partial scholarship
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G. Family Information.
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Father
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Mother
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Parents Name in Full
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- Living
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- Deceased
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- Living
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- Deceased
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- Together
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- Separated
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- Divorced
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Name of Stepparents (if appl.)
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Country of Birth
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Full Home Address (City, postal code, Street, No.)
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Telephone (Country code, city code, number)
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Mobile Phone (country code, number)
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E-mail
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Profession
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Employer
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Work phone, if appl. (Country code, city code, number)
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Brothers and sisters
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Name
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Sex (F or M)
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Age
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Occupation
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Living at Home?
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Participated in this program?
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If you have Friends or Relatives in USA or UK please provide full name, relationship, and address:
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Please write in your own handwriting the following statement:
My signature below indicates that all the information given is complete and correct to the best of my knowledge, and the essay is my work alone.
__________________________________________________________________________________________
__________________________________________________________________________________________
Signature (of applicant) ______________________ Date _______________
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Statements
To be signed by parents or guardians of all applicants
As the parent or guardian of the above-named candidate:
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I agree that my son/daughter will be an applicant for a Scholarship in the UK or the USA.
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I understand and agree that I will pay an administrative fee as follows: £1.500 towards my son’s/daughter’s scholarship if he/she is selected for a UK school or $ 3.750 if he/she is selected for a US school within ASSIST program.
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I confirm that our son/daughter has never been in an English-speaking country longer than two months, or attended English course abroad longer than one month.
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I confirm that I am aware that the Program cannot extend the scholarship.
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Signature of Male Parent or Guardian
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Signature of Female Parent or Guardian
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Date
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To be signed by parents or guardians of applicants for HMC program
As the parent or guardian of the above-named candidate,
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I understand and agree that my son/daughter will come home for the Christmas and Easter holidays and that I will meet the costs of transport to and from the UK at the beginning and end of each term.
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I confirm that total parental income during 2013 will not exceed the equivalent of £25,000.
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Signature of Male Parent or Guardian
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Signature of Female Parent or Guardian
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Date
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CHECK LIST
Please complete all of the following steps before submitting your application and check each box:
□ I have answered all of the questions on the application form (5 pages, this one included);
□ I have glued 1 recent passport size photo on page 1 of my Application form before copying the application;
□ My parents and I have read the information about the program stages and the financial conditions;
□ I have signed the application, as has at least one of my parents;
□ I have read the instructions for my personal essay (see below);
□ I have included some informal photos of my family and friends;
□ I have included 3 letters of recommendation (1 from my current English language teacher, 1 from my Mathematics teacher and 1 from my Class teacher) in signed and sealed envelopes;
□ I have included a copy of my last report card (“Удостоверение за завършен 9 клас”), translated in English and signed and sealed by the school administration – Не е нужна легализация);
□ I have included my Personal Essay (750 - 1000 words);
□ I have included a medium size (16cm x 23 cm) self-sticking envelope with a stamp on it (in-country mail) and my exact address (in Bulgarian) needed for the further correspondence of BulRA with me;
□ I have included the Davis (ASSIST) Application for Financial Aid (for applicants for Davis Scholarship);
□ I have included the receipt for the bank transfer amounting to 50 lv – administrative fee (Таксата се заплаща еднократно и не подлежи на възстановяване!).
Bank account (BGN) of Bulgarian Reading Association:
Българска Пощенска Банка, Клон “Солунска”, София 1000, ул. “Солунска” №15
IBAN: BG79BPBI79401054028601; BIC: BPBIBGSF, Титуляр: Българска асоциация по четене
На банковия документ да се посочат:
1)Tрите имена на кандидата и 2) Конкурс “Обучение на ученици в САЩ и Великобритания “ 2014/15.
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□ I have included 1 original and 1 copy of the application set (letters of recommendation, pictures & envelopes – in the original set only) in a large size envelope with my name, home address and my school name on (in Bulgarian and in English).
INSTRUCTIONS FOR YOUR PERSONAL ESSAY
Attach to your application a Personal Essay written by you in English, preferably typewritten or word-processed, about 750-1000 words in length, describing yourself and what makes you unique, using specific examples and interests. If any of your answers to the questions in the Application Form are not fully informative, please expand on them in your essay.
In addition, the following questions are suggested as the kinds of things you might like to discuss:
• Have you had an experience or a relationship that has particular importance to you?
• Describe briefly the various members of your family and what they mean to you.
• Tell us about your most common activities and interests, which you enjoy the most, and why.
• Do you belong to any clubs or other group organizations, and hold any special positions in them?
• Are you particularly interested and active, or particularly talented in any sports or hobbies?
• Do you have any special accomplishments ( artistic, musical or other cultural activities and/or talents)?
• Do you have any specific plans for the future?
• What are your reasons for wishing to spend a year in the UK or in the USA?
ДОКУМЕНТИТЕ СЕ ПОСТАВЯТ В ГОЛЯМ ПЛИК. С ПЕЧАТНИ БУКВИ СЕ ИЗПИСВА ИМЕТО НА КАНДИДАТА, ДОМАШНИЯT МУ АДРЕС, ИМЕТО НА УЧИЛИЩЕТО (НА БЪЛГАРСКИ И НА АНГЛИЙСКИ ЕЗИК). ИЗПРАЩАТ СЕ ПО ПОЩАТА НА АДРЕС: БЪЛГАРСКА АСОЦИАЦИЯ ПО ЧЕТЕНЕ, П.К. 205, 1000 СОФИЯ. ДОКУМЕНТИТЕ ЗА КАНДИДАТСТВАНЕ НЕ ПОДЛЕЖАТ НА ВРЪЩАНЕ!
БАЧ НЯМА ВЪЗМОЖНОСТ ДА ДАВА ОТГОВОРИ НА ЗАПИТВАНИЯ ПО ТЕЛЕФОНА.
СРОК ЗА ПОЛУЧАВАНЕ НА ДОКУМЕНТИТЕ: 28 НОЕМВРИ 2013.
ДОКУМЕНТИ ПОЛУЧЕНИ СЛЕД ТАЗИ ДАТА НЯМА ДА БЪДАТ РАЗГЛЕЖДАНИ!
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