EducationUSA_Academy

Application for EducationUSA Academy Connects Scholarship 2023

This application is the first step in being selected to win a scholarship to an EducationUSA Academy Connects program! For more information please go to: https://academy.educationusa.cl/
This application has 8 sections:

1) Applicant Information

2) Family information

3) Parent/Legal Guardian Information

4) High School Information

5) Essays

6) Personal records

7) Supporting Documents

8) Certification and Signature

Please note that if you leave this form before submitting it, you must click "Save" beforehand, otherwise your data may be lost.

Once you save the form, you will receive an email with a link to access it again. Only one application should be submitted per person. Once you "submit" your application, you cannot make changes.

If you have questions, please email: info@educationusa.cl

All answers should be written in English.

Applicant Information
Legal Name (same as your ID)*

First NameMiddle NameLast Names
Birthday*

MonthDayYear
Date
City of Birth*
City where you were born
Country of Birth*
Country where you were born
Country of citizenship*
Countries where you have citizenship
Country of permanent residency *
For example, you are a Brazilian citizen but have permanent residency in Chile.
RUT*
Gender

MaleFemaleOther
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityRegion
Home Phone Number
Mobile Phone Number*
9 #### ####
Have you been a participant in a U.S. Department Exchange Program?*

YesNo
If yes, which program?
Family information

Tell us about your household*

	Lives at home	Works	Level of study	Special circumstances (disabilities, illness)
Mother
Father
Sister
Brother
Other
Grandmother
Grandfather

Parent/Legal Guardian Information
Mother or legal guardian

Please fill out the following information about your mother or legal guardian.
Name*

First NameMiddle NameLast Names
Address (if different from the applicant)

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code
Email*
example@example.com
Phone Number *
Father or legal guardian

Please fill out the following information about your father or legal guardian. If you do not have a second legal guardian, skip this section.
Name

First NameMiddle NameLast Names
Address (if different from applicant)

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code
Email
example@example.com
Phone Number
High School Information
Name of the High School you attend *
School Type*

PublicSubsidized (particular subvencionado)Private
Who pays for your school tuition, (father, mother, parents, relative, other.)*
Do you receive a scholarship/financial support to pay for your school tuition? Yes/No. If yes, explain.*

Please list your GPA (Grade Point Average) (promedio de notas) for all high school years completed. (For example, if you are in 10th grade, only put the GPA for 9th grade). *

	GPA
9th grade (1° medio)
10th grade (2° medio)
11th grade (3° medio)

What are your Academic Interests:*
Example: Sciences, business, chemistry, music, engineering, etc.
What extracurricular activities do you participate in?*
In what year will you graduate?*

202420252026
How would you rate your English level?*

BeginnerLow-intermediateIntermediateHigh-intermediateAdvanced
If you know your English level based on the Common European Framework of Reference for Languages (CEFR), please select it below.
Name of a teacher that can serve as a reference: *
First and Last Names
Teacher's Email*
example@example.com
Essays

Please read carefully the following questions and thoughtfully type your essays in English in the spaces below.
1. Please explain why you want to be part of the program (limit 300 words)*

0/300
2. Tell us what you hope to gain from the online experience of EducationUSA Academy Connects (limit 200 words)*

0/300
3. Please explain why you want to study in the United States (limit 300 words)*

0/300
Personal records
Do you have a pending criminal charge OR have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? Note that you are not required to answer "yes" to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded,or otherwise ordered by a court to be kept confidential. (Misdemeanor traffic offenses are exempt)*

YesNo
Have you ever been placed on probation, suspended, expelled, or been subject to official disciplinary action from any high school or post secondary institution for any academic misconduct or behavioral misconduct?*

YesNo
Supporting Documents

Please upload the documents listed. Most file formats are accepted, doc, pdf, and jpeg are the most common.
Copy of National ID card (cedula de identidad) both sides*

Browse Files

Cancelof
Annual transcript (concentración de notas) for 9th grade (1° medio)*

Browse Files

Cancelof
Annual transcript for 10th grade (2° medio) (if applicable)

Browse Files

Cancelof
Annual trancript for 11th grade (3° medio) (if applicable)

Browse Files

Cancelof
TOEFL, TOEFL Junior, IELTS, or Cambridge score report (if you have one)

Browse Files

Cancelof
Certification and Signature

I understand that if selected, I will be traveling to the United States for a 3-4 week program during the months of July and August (exact dates vary according to the program). I hereby certify that, to the best of my knowledge, the information furnished on this application is true and complete. I understand that, if found to be otherwise, it is sufficient cause for refusal or dismissal.
Applicant's Signature*
First and Last Names
Date of Signature (Month/Day/Year)
Should be Empty:

Application for EducationUSA Academy Connects Scholarship 2023

Applicant Information

Family information

Parent/Legal Guardian Information

Mother or legal guardian

Father or legal guardian

High School Information

Essays

Personal records

Supporting Documents

Certification and Signature