PUBLIC AFFAIRS SECTION U.S. EMBASSY IN ULAANBAATAR

E-Teacher Scholarship Program AY2014-2015 APPLICATION FORM

PUBLIC AFFAIRS SECTION, U.S. EMBASSY IN ULAANBAATARE-mail: pao@usembassy.mn

Tel: 7007-6001Please submit the completed request form to the email address above by September 15, 2014.

In the subject line please indicate the name of the program“E-Teacher Scholarship Program 2014-15”and your last name.

1. PLEASE CONFIRM THAT YOU MEET THE REQUIREMENTS OF THE PROGRAM BY CHECKING THE BOXES BELOW:

__ Yes, I have regular and reliable access to high-speed Internet connection __ Yes, I have required English language reading and writing/typing skills __ Yes, I commit to spending 10-15 hours a week on-line to participate in the course__ Yes, I commit to share the gained knowledge through making presentations in my region and at the Embassy initiated events in other regions of Mongolia.

2. CONTACT INFORMATION

FIRST NAME:

LAST NAME:

PRIMARY E-MAIL ADDRESS:

SECONDARY E-MAIL ADDRESS:

CELL PHONE NUMBER:

MAILING ADDRESS:

POSTAL CODE:

CURRENT POSITION

PUBLIC AFFAIRS SECTION U.S. EMBASSY IN ULAANBAATAR

(Please specify name of institution and starting date)

Dates Position and Institutional Affiliation ResponsibilitiesMM/DD/YYYY – MM/DD/YYYY

*CONCURRENT POSITIONS, if any

Dates Position and Institutional AffiliationMM/DD/YYYY – MM/DD/YYYY PREVIOUS POSITIONS(Provide dates starting with most recent and working back)

Dates Position and Institutional AffiliationMM/DD/YYYY – MM/DD/YYYYMM/DD/YYYY – MM/DD/YYYYMM/DD/YYYY – MM/DD/YYYY

PUBLICATIONS OR ACADEMIC PRESENTATIONS(Provide the three most recent ones)

1. 2. 3.

MEMBERSHIPS

1. 2. 3.

EDUCATIONAL BACKGROUND

PUBLIC AFFAIRS SECTION U.S. EMBASSY IN ULAANBAATAR

(Include dates, degree, academic institution, area of specialization)

Dates Degree, area of specialization Academic InstitutionMM/DD/YYYY – MM/DD/YYYYMM/DD/YYYY – MM/DD/YYYYMM/DD/YYYY – MM/DD/YYYY

- Have you ever visited the United States? If yes, when and for how long:

- Have you ever participated in the e-teacher program? If so, which course and what year?

3. E-TEACHER COURSES THAT ARE OFFERED 2014-2015 Please list the top three courses that you’d like to participate in (please note that you may not be selected for your first choice)

1. Introduction to Pedagogy and Practices for Teaching English to Speakers of Other Languages (TESOL Methods)

2. Building Teaching Skills through the Interactive Web (Web Skills)3. Teaching English to Young Learners (TEYL)4. Teaching English to Pre-teens and Teens (TEPT)5. English for Specific Purposes, Aligning Context with Practices and Materials (ESP)6. MOOC7. Summative and Formative Assessment in language Learning and Teaching (Assessment)8. Critical Thinking in Language Learning and Teaching (CT)9. Practical Applications in Listening and Speaking Skills (PALSS)

4. PLEASE INDICATE WHICH OF THE SEMESTERS YOU WILL BE AVAILABLE TO PARTICIPATE IN THE COURSE

__ Fall 2014 __ Winter 2015 __ Spring 2015 __ Summer 2015

5. STATEMENT OF PURPOSE

PUBLIC AFFAIRS SECTION U.S. EMBASSY IN ULAANBAATAR

Explain why participation in the course is important for you and how and where you are going to share the gained knowledge. Please give specific examples as to why this particular topic is relevant to your teaching. Please indicate your level of English, the number of years you have taught, and the age group of your students.