Nine-month Language Program Summer Language Program

Hindi Bengali Tamil other (specify)

Years of study in this language by 1 June :

Surname First Name Middle Initial

Social Security number Passport number

Citizenship (if not USA, explain residency status) ______________________ Sex___ Birthdate _____________________

Mailing address

Permanent address

Telephone number Email

University

Department Educational Status

Faculty adviser (name, address, e-mail) _____________________________________________________________________________

_____________________________________________________________________________________________________________

Colleges and/or universities attended Dates degree earned/date major GPA

1.

2.

3.

4.

Please list all academic honors, fellowships, and the places and periods of any visits abroad for purposes of research or education

Please list the names of the persons you have asked to write recommendations on your behalf

1. Language reference (name, title, address)

2. General reference (name, title, address)

3. General reference (name, title, address)

Do you have any illnesses likely to interfere with your ability to carry out the proposed program of study?
Please explain

Please list any previous visits you have made to India
date location purpose of visit
1.
2.
3.

Please list the names of funding sources to which you have applied for financial aid for the period of the proposed program of study. (Applicants to the Summer Language Program should note that the American Institute of Indian Studies does not offer summer fellowships)

On a separate sheet, explain in 300 words or less how the proposed program of study will build on your previous language, area, and disciplinary training, and how it will contribute to your immediate and long-range academic and professional goals. It is not necessary to talk about the value of overseas language training in general. This statement is a crucial part of your application.

Signature of applicant Date

10/00