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ASIA PACIFIC LEADERSHIP PROGRAM (APLP) APPLICATION 2014 2015

Scholar h!" D#a$l!%#& D#c#'(#r 1) 201* + La,# A""l!ca,!o% & March 1) 2014
Please refer to the application instructions for the APLP on our website ( see link below) and the specific requirements of the program before completing this form. Print in black ink or type answers. If other name(s) appear on your official records, list such name(s). ! "!# $%I#& I" '(A & A%&A'.

www.eastwestcenter.org/aplp
1. Type of APLP Application 2. Optional: I wish to be considered for financial New assistance (Required: Submit the Verification of Funds Reapplying Year(s) previously applied: beyond the EWC Entrance Fellowship Form.) 3. Family name Given name Middle name(s) Other name(s) 4. Gender Male (as it appears on your passport) Female 5. Complete current or local mailing address including street & apt. #, city, state/country, postal/zip code 6. Address valid until: (month/year) 7. Complete permanent mailing address including street & apt. #, city, state/country, postal/zip code 8. If not U.S. citizen but currently in U.S., indicate visa status: J F Other 9. Birthdate 10. Birthplace (city/state/country) 11. Country of citizenship 12. Country of permanent (month/day/year) residence 13. Passport number, issue/expiration date, place of issue 14. If U.S. green card holder, alien registration # 15. Office Phone # ____________________________ Home Phone # ____________________________ Cell Phone # 18. E-mail address 20. EDUCATION: List in order of your attendance all colleges/universities in which you have enrolled. Include the one in which you are currently enrolled, if applicable. Begin with the most recent. Name of institution Location Date Major Degree or Date (City, State or From To Diploma (BA, Received / Country) Mo/Yr Mo/Yr MSc, PhD) Expected 16. Are you of Native Hawaiian ancestry? If so, please provide a copy of your OHA Registry card. 17. For US citizens: What is your home state?

19. Have you previously participated in an EWC program? If so, specify dates and program name.

21. CURRENT STATUS: I am presently employed as a: Address: I am presently enrolled as a: or

at:

classified (degree-seeking) student at ________________________________________________________ unclassified student at ____________________________________________________________________

22. PROFESSIONAL WORK EXPERIENCE (Begin with your most recent employment.)

Dates To/From

Position/Title

Employer

City/Country

Name

Position

23. LETTERS OF REFERENCE

24. TEST/EXAMINATION REQUIRED FOR NON-NATIVE SPEAKERS OF ENGLISH (Please refer to the instructions and Frequently Asked Questions (FAQ) section of the APLP website for full details on TOEFL or IETLS requirements and exemptions. Applicants must meet the stated requirements of the East-West Center.) Date taken Score Date taken Score TOEFL _________ _________ or IELTS-Academic only _________ _________

******************************************************PLEASE DO NOT WRITE BELOW THIS LINE*********************************************

Cover Letter Rsum or Curriculum Vitae Essay Letters of Reference _____1 _____2 _____3 Official Transcripts/Degree Certifications TOEFL or IELTS Score ______ Meets req.? __Y __N Verification of Funding Financial Need Statement

ASIA PACIFIC LEADERSHIP PROGRAM (APLP) APPLICATION 2014 2015 )amily "ame *i+en "ame ,iddle "ame(s)

Pa-# 2 o. 2 !ther name(s)

Th# .ollo/!%- !,#' ar# r#01!r#$ a "ar, o. 2o1r a""l!ca,!o% ,o ,h# APLP3 Pl#a # 1('!, ,h# .ollo/!%- # a2 a%$ $oc1'#%, !% har$ co"2 alo%- /!,h 2o1r or!-!%al) !-%#$ a""l!ca,!o% .or'3 R#4!#/ a%$ !-% ,h# 5A""l!ca%,6 C#r,!.!ca,!o%7 o% ,h# (o,,o' o. ,h! "a-#3 13 Co4#r L#,,#r3 In the co+er letter, state why you are applying to the Asia Pacific Leadership Program and how you hope to benefit from the e-perience. &-plain how the APLP fits within the conte-t of your past e-periences and your future plans. iscuss how you will contribute to the international community of the APLP and the &ast.$est /enter. 23 R8 1'8 or C1rr!c1l1' 9!,a#. In addition to your work e-perience and higher education, summari0e1 a. 'cholarships, fellowships, grants or awards you ha+e recei+ed, including academic, professional or community ser+ice recognition2 b. Positions of leadership that you currently hold or ha+e held2 c. Publications you ha+e authored2 d. /ountries in which you ha+e tra+eled e-tensi+ely or resided, especially in the Asia Pacific region2 e. Particular interests, e-periences, skills and talents that may be rele+ant to the APLP2 f. /ommunity ser+ice or ci+ic engagement acti+ities2 and g. Personal accomplishments which you feel are significant. *3 E a2 ('a:!'1' 500 /or$ ,2"#$)3 $rite an essay answering (o,h of the following questions1

In your opinion, what is the core issue facing the Asia Pacific region today3 $hat type of leadership is required .ro' 2o1 to address this issue3 43 9#r!.!ca,!o% o. F1%$ .or E:"#% # (#2o%$ ,h# E;C E%,ra%c# F#llo/ h!"3 A completed form and funding statement are required for any applicant who would like to be considered for supplementary scholarships. 53 S1""or,!%- Doc1'#%, S1('!, all r#01!r#$ 1""or,!%- $oc1'#%, (L#,,#r o. r#.#r#%c#) o..!c!al ,ra% cr!", +$#-r## c#r,!.!ca,!o% ) TOEFL or IELTS cor#) ,o ,h# Ea ,<;# , C#%,#r A/ar$ S#r4!c# O..!c# ,o co'"l#,# 2o1r a""l!ca,!o%3 =3 (ow did you learn about the Asia Pacific Leadership Program3 Please check all that apply1 "ewspaper or maga0ine 'cholarship database Internet search5 &$/ web site &mail Announcement Poster &$/ staff (name1 Professor (name1444444 /urrent or former &$/ fellow (name1 &$/ information session (location1 *raduate department6uni+ersity (name1 &$/ Program %epresentati+e (name /onference (name1 &ducational ad+ising office1 !ther1 (please e-plain1 ) ) ) ) ) ) ) ) )

APPLICANT>S CERTIFICATION I hereby certify that the information I ha+e gi+en on this application and supporting documents is complete and correct to the best of my knowledge, and that I ha+e attended no institution other than those listed on this application. I understand that the concealment of such information may result in the re7ection of my application or disciplinary action if disco+ered after enrollment. I understand that it is my responsibility to arrange for the forwarding of official transcripts of records from all schools specified in the instruction booklet, and that such transcripts and other application materials become the property of the &ast.$est /enter and will not be returned to me. )urther, I authori0e access to and if necessary, release of my educational records of any academic work done at the 8ni+ersity of (awai9i as part of the e+aluation of my application by the &ast.$est /enter.

'ignature of Applicant

ate

Pl#a # 'a?# "ho,oco"!# o. 2o1r a""l!ca,!o% $oc1'#%, .or 2o1r "#r o%al r#cor$ (#.or# 1('!,,!%- ,h#' ,o ,h# Ea ,<;# , C#%,#r3 Th# Ea ,<;# , C#%,#r /!ll %o, 'a?# "ho,oco"!# o. a%2 'a,#r!al 1('!,,#$ a "ar, o. 2o1r a""l!ca,!o%3