Application for

Iraqi Women Fellowship Foundation (IWFF) Faculty Program

COVER SHEET

Name:
Family First Middle
Gender:

City: Country:

Country of Current Citizenship:

City of Birth: Country of Birth: Date of Birth:

Home phone: Mobile number:

E-mail (Required):

Do you have, or have you ever held the following (Circle “Yes” or “No” for each line):
U.S. citizenship? Yes No
U.S. dual citizenship? Yes No
U.S. permanent residency? Yes No
Have you been convicted of a crime? Yes No

Do you currently hold an Iraqi G passport? Yes No

If no, when do you plan to apply for one?

TOPICS OF INTEREST: Please select the three topics that interest you most. We will use this
information to find the most suitable program for you.
Nanoengineering Energy and the environment (engineering, infrastructure and policy)
Bioengineering Industrial Engineering & Operations Research
Computer Science Telecommunication and Information Technology
Nuclear Engineering Civil and Environmental Engineering Mechanical Engineering
Materials Engineering Engineering in Medicine Electrical Engineering
Other: ________________________________________________ Women in Science

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Iraqi Women Fellowship Foundation (IWFF) Faculty Program 2011
Full Name:

**** Please answer ALL questions as accurately and completely as possible****

EDUCATION
List secondary and educational institutions attended in reverse chronological order, including any in
which you may be presently enrolled.
Dates Date
Institution and Major Field of (Month/Year) Actual Name of Received
Location Study Degree or Diploma or
From To
Expected

List scholarships or fellowships held at present or in the past (Give source or sponsor, amount,
where held, and duration.)

Indicate any academic honors or prizes which you have received, with titles and dates.

List any books, articles or theses published by you, especially in your proposed field of study.
(Give title, place and date of publication.)

List professional societies, fraternities or other organizations in which you now hold membership
or in which you have been active in the past (Indicate if you have held an elective office).

Teacher Training: (Please describe any teacher training you have had.)

Research: (Include any research you have completed or in which you are currently involved.)

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Iraqi Women Fellowship Foundation (IWFF) Faculty Program 2011
Full Name:

ESSAY
Attach an essay on the following topic as a separate sheet of paper with your application.

Please write a clear and detailed description of your academic and career objectives and the
reasons why you wish to pursue them. Discuss your goals both in terms of your field of study in
general and within your specific area of specialization and how it relates to your academic and
professional background, your objectives for the future, and how it will benefit your home
country.

OCCUPATIONAL EXPERIENCE: (List positions held, beginning with the most recent employment)

Dates (Month
Name of Employer Address of Employer Title/Type of Work Year)

From To

How will you use this fellowship in carrying out your duties upon your return?

How do you plan to share the knowledge and skills you acquire in the U.S. with your colleagues
when you return?

List any specific interests or areas of focus you have in engineering or applied sciences.

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Iraqi Women Fellowship Foundation (IWFF) Faculty Program 2011
 Full Name:

LANGUAGE SKILLS:

Mother Tongue: How many years have you studied English?

Rate yourself excellent, good, fair or poor. Include all languages in which you have some competence.
Language Reading Writing Speaking
English

EXAMINATION DATES AND TEST SCORES: (Date if taken or future date for taking exams)

Date For GRE General or Subject Exams

Total Percentile
Test Type (Month/
Score (%) Q A
Year) Verbal V % Quantitative Analytical
% %
TOEFL
ITP
GRE
GRE Subject
Other:
Other:

If you have traveled, lived, worked or studied in any country other than your own for more than a
month, indicate places, dates and reasons. (Education, research, business, vacation, etc.)

EMERGENCY CONTACT: Name, address and telephone number of individual to be notified in case
of emergency

Name
Street City Country
Telephone Email

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Iraqi Women Fellowship Foundation (IWFF) Faculty Program 2011
NAME:

ATTACHMENTS—REFERENCES
List the names of persons from whom you have requested letters of reference. Letters of
reference may be submitted by email, directly from the referee, or in a sealed envelope attached
to your application. A reference letter form is attached to the application.

Name Position Email Address

1.

2.

3.

ATTACHMENTS—OTHER:
Please include the following additional documents, as applicable, with your application.
1. Certificate, in English, of highest level degree completed*
2. Final transcript, in English, of highest level degree completed*
3. Three letters of recommendation from professors and/or supervisors [please use the
recommendation form included in this application]
4. Summary of work experience (CV)
5. One recent photo
6. Copy of identification [national ID or passport]
7. TOEFL/ITP and GRE test scores – test scores or test registration confirmations, as
applicable, must be submitted.
* If not in English, please attach an accurate translation.

How did you learn about this program? (Please circle one.)

Colleague Friend/relative AMIDEAST Website

University Poster/Flyer Other: ______________

I authorize AMIDEAST to: Yes No

1) to receive, and/or to request any test score reports;
2) to send any of the above score reports to U.S. institutions on my behalf;
3) to place me at U.S. institution, as chosen by AMIDEAST and IWFF

By checking this box, I certify that, to the best of my knowledge, the information provided in
my application is accurate and complete and that I intend to return to my home country upon
completion of my studies in the United States. I authorize any school or university which I
have attended or will attend to release my transcripts and any report to AMIDEAST.

Signature of Applicant Date:

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Iraqi Women Fellowship Foundation (IWFF) Faculty Program 2011
APPLICANT’S FULL NAME:

CONFIDENTIAL LETTER OF REFERENCE

Iraqi Women in Engineering and Applied Sciences (IWASE)
Fellowship Application
This letter of reference must be written by a supervisor under whom the applicant has taught, or
by a teacher under whom the applicant has studied, in the field of engineering and/or applied
sciences. The letter must be in English. If not in English, an accurate translation must be
attached.

NAME OF REFEREE: TITLE:

INSTITUTION OR BUSINESS:
ADDRESS:
CITY: COUNTRY: POSTAL CODE:
PHONE NUMBER: EMAIL ADDRESS:

HOW LONG HAVE YOU KNOWN THE APPLICANT?

IN WHAT CAPACITY HAVE YOU KNOWN THE APPLICANT?
Teacher/ Professor Employer/Job Supervisor Research Advisor Other (please specify)

PLEASE EVALUATE THE APPLICANT IN COMPARISON WITH OTHER STUDENTS YOU HAVE
KNOWN IN YOUR PROFESSIONAL CAREER.
Very Below Not
Excellent Good Average Average Applicable
Intellectual Ability
Knowledge of Field
Work Habits
Seriousness of Purpose
Resourcefulness and Initiative
Emotional Maturity
Adaptability to New Situations
Leadership Qualities
Teaching Potential

Additional Comments:
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Signature: Date:
The referee may email the letter of reference to [email protected] or enclose the reference in a
sealed envelope and give it to the applicant to submit with their application.
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Iraqi Women Fellowship Foundation (IWFF) Faculty Program 2011
Submit your application as hard copy to one of the following locations or by email (with scanned
attachments) to [email protected]

AMIDEAST Office in Baghdad:

Jhadria, Al-Rajah Foundation building, near Babel hotel, Second floor, Sunday –Thursday 9am-4pm,
07806 209 267 [email protected]

AMIDEAST Office in Erbil:

Ainkawa Neighborhood close to Ashtar TV nearby Mar-Youhannah church, Sunday- Thursday 8am-4pm,
0750 445 9383 [email protected]

AMIDEAST representative in Basra:

University of Basra, Bab Al-Zubair Compound, in Institute of Live Languages, Mondays 9am-1pm, 0780
547 9398 [email protected]

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Iraqi Women Fellowship Foundation (IWFF) Faculty Program 2011