Appendix 1

Opportunity Funds (OF)

2017 Award Application Form

Personal Data

Male
Full Name: Female
Last First M.I.
Permanent Home Address:
Street Address Apartment/Unit #

City/Town State/Province
Phone: E-mail Address:

Date of Birth: Place of Birth: ID Number:

First Language: Language spoken at home:

Other Citizenship

Citizenship: US Citizen Dual US/_______ Citizen US Permanent Resident Visa
YES NO If yes,
Have you ever applied or received a US visa? when?

If yes, what type of visa?

YES NO If yes, please explain relationship
Do you have relatives in the US?
Marital
Status: Single Married Widowed Separated Divorced Date:
Possible area(s) of academic
concentration: Undecided
Possible career or
professional plans: Undecided
YES NO
Will you be a candidate for financial aid?

Education
Institution you
now attend: Address:
Date of Date of Home
Entry: Graduation: Type of School: Public Private Municipal School

Degree(s) Obtained: High School Diploma Date: Licenciatura (B.A./B.S.) Date:

Masters (M.A. /M.S.) Date: Doctorate (Ph.D.) Date:

List all academic institutions and other programs you have attended since ninth grade

Name of School Location (City, Province, Country) Dates Attended

List all colleges/universities at which you have taken courses for credit
Name of
College/University Location (City, Province, Country) Dates Attended Degree(s) Earned

Not currently attending school

Test Information
Test of English as a
second language
(TOEFL) Test Type: Date taken: Score:

GRE General Date taken: Verbal: Quantitative: Analytical Writing:

GMAT Date taken: Verbal: Quantitative: Analytical Writing:

SAT I Date taken: Verbal: Math: Writing:

SAT II Subject Tests Date taken: Subject: Score:

Date taken: Subject: Score:

Date taken: Subject: Score:

Combination
English: Math: Reading: Science: Composite: English/Writing:
ACT Date taken:

If any other tests taken: Test: Date taken: Score:

Family

Male
Parent/Guardian 1: Female
Last Name First M.I.
Mother Father Legal Guardian Living? Yes No Date deceased:

Home address if different from yours:

Home phone:

E-mail:

Occupation:

Name of employer:

High School/University (if any):

Highest degree obtained: Year:

Male
Parent/Guardian 2: Female
Last First M.I.
Mother Father Legal Guardian Living? Yes No Date deceased:

Home address if different from yours:

Home phone:

E-mail:

Occupation:

Name of employer:

High School/University (if any):

Highest degree obtained: Year:

Parents' Marital
Status: Never Married Married Widowed Separated Divorced Date:

With whom do you make your permanent home? Parent 1 Parent 2 Both Other
Please give names and ages of your brothers and sisters, high schools, colleges and universities attended, degrees,
and dates

Name/Relationship Institutions Attended Degree(s) Earned Dates

Academic Honors

Briefly list or describe any academic distinctions or honors you have received since the ninth grade

Work Experience

Please list principal jobs you have held during the past three years, including summer employment

Type of Work Employer Approximate Dates Hours per week

 Financial Information

Head of household: Father If other, explain:

Monthly income: Equivalent in US$:

Sources of income:

Number of household members:

Number of dependents:

Tuition of last institution attended:

Please list any scholarships or awards:

Please list or describe monthly
expenses within your household
(housing, tuition, basic amenities, etc.):

I certify that all information in my application is accurate to the best of my

knowledge.

Signature Date: (mm/dd/yyyy): / /

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Appendix 2
 Opportunity Funds (OF)
2017 Applicant Essay Form
Essay must be written in English and a minimum of 300 words
The purpose of this exercise is to:
- Help you determine and articulate what you believe makes you
unique from the other applicants.
- Help you identify your areas of interest and research so that you are
prepared to begin researching undergraduate/graduate degree
programs, and
- Prepare you for answering the comprehensive questions to be
answered in writing your statement of purpose.

Choose one of the following five questions. Write a short essay in English of
200 to 400 words answering the question.
1. Who were/are your favorite teachers in your high school/undergraduate
program, and why? How has each influenced you?
2. What are some of the encouraging words and compliments others have
said to or about you over the years?
3. What experiences in your life, academic and other, have influenced your
academic and career direction?
4. What experiences from your family life have contributed to your choice to
study in this particular field of study?
5. How have you prepared yourself to succeed in undergraduate/graduate
school?
Thank you!
Signature: _____________________ Date: (mm/dd/yyyy): / /