YSEALI Academic Fellowship Spring 2023 Application Form

Spring 2023 YSEALI Academic Fellowship Application Form

Application Deadline - October 28, 2022
The U.S. Embassy Dili is pleased to invite Timorese young leaders age 18-25 years old (YSEALI Registered Member) who are currently enroll or study at a university to apply for the Spring 2023 YSEALI Academic Fellowship Program.

The five-week programs are planned to take place in-person during the mid-March through late May timeframe; should healthy, safety and travel conditions pose sigificant challenges, the program will pivot to a modified virtual format. Six (6) Timorese applicants will be selected, with distributions per theme as following: Civic Engagement theme (2), Environmental Issue theme (2), Social Entrepreneurship and Economic Development theme (2)

APPLICATION DEADLINE: Friday, October 28, 2022 (17:00 PM - Local Time). If you have any difficulties or questions, please contact: ysealitimor@state.gov or +670 3324-684 ext. 2034

Only YSEALI members are eligible to apply for the Spring 2023 YSEALI Academic Fellowship Institute Program. If you are not yet a member, please sign up here: www.yseali.state.gov (registration is free!)
Yes, I have
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. Basic Information:

Tell us about yourself
Full Name (as in passport)*

First & Middle Name Last Name
Place of Birth
Birthdate:*

MonthDayYear
Mobile No. :*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
Emergency Contact
Complete Name:*
Relationship *
Mobile No. :*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
Home Address :*

Street Address

Street Address Line 2

CityPost Administrator

Postal CodeCountry
YesNo
FemaleMaleOther
Choose YSEALI THEME: Please choose carefuly on YSEALI theme that you are applying for: Civic Engagement, Environmental Issues, or Social Entrepreneurship and Economic Development.
Civic Engagement (CE)Environmental IssuesSocial Entrepreneurship and Economic Development
Medical or physical considerations (please describe any pre-existing medical conditions, including any prescription medication you may be taking, or any other dietary or personal consideration. This will not affect your selection but will enable the host institutions to make any necessary accommodations). Dietary, personal or religious consideration (i.e., vegetarian, gluten-free, halal, etc.) :

Yes.No
If yes, please describe:

0/300
II. Academic Information:

High School and University
YesNo
Program or subject of study:
Subject and in what year: (i.e: 1st year, 2nd year, 3rd year, graduated etc.)
University:
High School activities, community activities, volunteer work (please list and include dates (i.e., YSEALI Workshop, June 5th, 2019)
Membership in Associations, Clubs, Organizations, etc., (i.e., UmaAmerika, June 2018 to June 2019)
Work History (if applicable: please mentioned current employer, start date (M/D/Y), current title and position, duties and responsibility):
III. International Experience:
Passport Number & Expiration Date (If you currently have a passport):
Yes.No.
If yes, please provide purpose of your travel and dates regarding your past travel to the U.S. (Example, Summer work and Travel program California, 15 June - 24 August 2017) :
Yes.No.
If yes, please provide name, relationship, city, and state of your family member (example: Clinton, Brother, Manhattan, New York):
VII. Essay

This is the most important components of this application. Your essay should be 100 words. In your essay, please describe your professional and personal goals, your interest and motivation to take part in this fellowship.
Please write a short biographic paragraph that would be used on the program website to tell others about you if you should be chosen for the program. Please write in the third person (i.e., Mr./Ms. or he/she). *100 words
Essay:

0/500
What about your background and/or interests makes you competitive for the YSEALI Academic Fellowship spring 2023? *100 words
Essay:

0/500
How will the Fellowship affect you personally and professionally? *100 words
Essay:

0/500
Please describe a specific challenge in your community, country, or the ASEAN region that relates to the theme you are appliying for and why you want to address it. *100 words
Essay:

0/500
VI. Validating Application:
I understand that by applying to YSEALI Academic Fellowship Program:

I will be expected to be a diplomatic representative of my country. I commit to fulfilling all requirements of the program. I will complete all program requests for information by the stated deadlines. I will be open to the cultural differences experienced during the program in the U.S., including differences in society, food, and weather.

I understand that i will be rooming with someone of another country and/or religion and confirm that I am willing to do so. (The institutes will only matches individuals of the same gender withing rooming assignments.)

I certify that the information given in this application and all attached materials is complete and accurate to the best of knowledge. In signing this application i certify that i am not an employee, spouse, or a dependent of an employee of the U.S. Department of State. I understand that in addition to the selection process outlined in this application, the final descision of my application and my status as a YSEALI Academic Fellow is contingent upon program funding, on the ability of the U.S. Department of State to place me at an appropriate U.S. university, and on my ability to receive and maintain a J-1 visa to the United States. If selected as a YSEALI Academic Fellow finalist, I agree to abide by the stipuations of the J-1 visa requirements, and by all program regulations, and to return to my home country for a minimum of two years upon completion of the YSEALI Academic Fellows Program.

I agree with the above statement and i confirm that everything contained within this application is true and accurate.
VIII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application and agree with the statement above. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Should be Empty:

Spring 2023 YSEALI Academic Fellowship Application Form

I. Basic Information:

Emergency Contact

II. Academic Information:

III. International Experience:

VII. Essay

VI. Validating Application:

VIII. Applicant's E-Signature