Applying for year

Personal Data

1. Name:

Example:
Abby G. Montes

2. Current Mailing Address:

Example:
Apt. 321, Puuhale Rd, Wailuku, HI 96723

3. E-Mail:
e-mail will be the primary means of communication for this program.

Example:
agmontes@hawaii.edu

4. Telephone: 5. Fax:

6. Times best reached at these numbers:

7. Are the above address, telephone and fax numbers and times valid until the time immediately prior to departure? Yes | No

If the answer is NO provide alternative address, telephone and/or fax numbers where you can be reached immediately prior to departure.

Address:

Email:
Telephone:
Fax:
Valid from/to date:
Times best reached at these numbers:

Current telephone numbers are necessary because you will be interviewed by telephone.

8. Citizenship:

US citizen | Permanent resident | Neither

Educational Background

9. Please list all college or university training undertaken to date. List current degree program first. Include the following items for each:
Institution, Department/Major, Degree, Date Completed

Number and double space between each institution.

Current Status

10. Pre-Summer Abroad (choose 1):

Junior | Senior | MA student | PhD student | Teacher | Administrator | Other

11. Students please indicate institution, department/program, anticipated degree and date. Teachers list school, grade/level, subject area. Administrators include school or institution. Others -- please explain.

12. Post-Summer Abroad (choose 1):

Junior | Senior | MA student | PhD student | Teacher | Administrator | Other

13. Students please indicate institution, department/program, anticipated degree and date. Teachers list school, grade/level, subject area. Administrators include school or institution. Others -- please explain.

Future Plans

14. If you are not a teacher, do you intend to pursue a teaching career? Yes | No

15. If yes, in what field?

Knowledge of Khmer

16. Have you had 2 years of Khmer at college or university? Yes | No

17. Please list all training you have had in Khmer. Include the following items:
a. the name of the institution (college or university, Peace Corps, etc.),
b. the type of instruction (academic course, private tutoring, etc.),
c. the length of your training (3 semesters, 2 years, etc.), and
d. the skill emphasized (speaking, reading, etc.).

Number and double space between each institution.

18. Residence in Cambodia.

Have you lived in Cambodia? Yes | No

If you have spent any time in Cambodia, please list briefly, including the following items:
a. length of time you you spent there (2 year, 6 months, 10 days, etc.),
b. purpose for going (PCV, studies, tourism, etc.), and
c. degree to which you relied on your ability to use Khmer in your daily life.

Number and double space between each time.

19. Residence of Family and Friends Who Reside or Work in Cambodia

Do you have family or friends who live in Cambodia? Yes | No

If you have family or friends who reside or work in Cambodia during the time that you will be there, list their name and contact numbers in case of emergencies.

Number and double space between each person.

References

20. Please list three people you have asked to write letters of reference for you. Each should include name and position

Example:
Jaime Gonzales, Khmer instructor, Short Beach State College

Financial Aid

21. Are you an applicant for financial aid (U.S. citizens and permanent residents only) Yes | No

SEASSI or Other Program

22. The Advanced Study of Khmer Language program cooperates with the Southeast Asian Studies Summer Institute, and applicants are advised to apply to both programs to ensure that they are accepted by the one that is more appropriate for them.

Applying to SEASSI? Yes | No

If you are applying to a different program, please tell us what it is:

Personal Statement

23. Personal Statement outlining academic and/or career goals. Indicate how participation in the program will help to achieve those goals.

If there are any further details regarding your prior education and/or training in Khmer that you think may be useful for the selection committee, please discuss in the Personal Statement.

APPLICANTS MUST ANSWER ALL QUESTIONS ON THIS APPLICATION. FAILURE TO DO SO MAY INVALIDATE THE APPLICATION.