American Councils

1. Personal Information:

Last Name:

First Name:

Middle Name:

Name at Time of Application to FLEX:

Date of Birth: Month: Day: Year:

Year of Return from FLEX:

Programs in which you have participated in addition to FLEX (circle all that apply):

LEAP

UGRAD

TEA

PIE

MUSKIE

MUSKIE PhD

Fulbright

RSEP

JFDP

Other

Program Start Year and End Year:

2. Contact information where we can best reach you:

Country:	Postal Code:
Region:	City:
Street Address:	This address is your (circle one):
Preferred Phone (Country & city code & Number):	This phone is (circle one):
Mobile Phone (Code & Number):	Home phone (Code & Number):
Other Phone (Code & Number):	Fax (Code & Number):
Preferred Email Address:	Other Email Address:

3. Alternate Contact (person who will know how to reach you):

Last Name:	Relationship to You:
First Name:	Middle Name:
Country:	Postal Code:
Region:	City:
Street Address:	Email Address:
Preferred Phone (Code & Number):	Other Phone (Code & Number):

4.Education after completing the program:

Name of Institution:

Country/ City:

Department:

Year of: Entry: Graduation:

Field of Study (please, select one):

Accounting and Audit
Advertising
Agriculture and Forestry
Anthropology
Archaeology
Architecture
Area/ Regional Studies: (select one)

Art History
Automobile Industry
Aviation
Banking and Finance
Biochemistry
Biology
Building and Construction
Business Administration
Chemistry
Computer Science and Programming
Conflict Resolution
Cross-cultural Communications
Design
Diplomacy
Economics
Education: Curriculum/ Policy/ Special Needs

Engineering and Electronics
Entrepreneurship and Commerce
Environmental Studies
Ethnic studies
Finance and Credit
Foreign Languages

Specify:

Gender Studies
Geography
History
HR Management
Human Rights
Insurance
International Relations
Investment and Credit Analysis
IT
Journalism, Media and Communication
Law
Library and Museum Studies
Linguistics and Intercultural Communication
Literary Studies and Creative Writing
Management
Marketing
Mathematics
Medicine/ Surgery/ Pharmacy/ Veterinary

Military Sciences
Oil and Gas Technologies
Performing Arts: Music, Dance, Theatre
Philology
Philosophy
Physics and Astronomy
Political Science
PR
Psychology
Public Administration
Religious Studies
Social Work
Sociology
Statistics
Taxation
Teaching

Specify:

Television, Film and Animation
Tourism and Hotel Business
Translation and Interpretation
Visual Arts: Painting, Photography, Sculpture
World Economics
World Politics
Other:

Specify your subject of studies:

Degree:

Bachelor’s

Master’s

PhD

Other

Honors or Awards:

5. Primary Employment:

Company Name:

Title:

Professional Field/ Industry (please, select one):

Accounting
Agriculture/ Mining
Architecture/ Design
Arts/ Entertainment
Automotive
Computers/ Software/ Technology
Construction/ Engineering
Consulting
Education/ Teaching
Energy/ Utilities/ Fuel/ Chemicals
Finance/ Banking
Government/ Social Services

Health Care/ Hospitals
Human Resources/ Recruiting
Import/ Export/ Trade/ Wholesale
Information Management/ Library
Insurance
International Relations/ Diplomatic Services
Legal
Manufacturing
Marketing/ Advertising/ Communications/ PR
Media/ Publishing/ Broadcasting
Military/ Defense

NGOs/ Non-profit Organizations
Pharmaceuticals/ Biotech
Political Science
Real estate/ Property Management
Research & Development
Retail
Telecommunications
Translation/ Interpreting
Transportation/ Logistics
Travel/ Tourism business
Other:

Country/ Postal Code:

Region/ City:

Street Address:

Email Address:

Work Phone (Code & Number):

Work Fax (Code & Number):

Web Site:

Start Date: Month: Year: