APPLICANT
First Name: Sex: Home Address Facebook ID Birth Date: Nick Name: Last Name: Birth Place: E-mail: Skype ID / Other ID Pirtskhalaishvili Citizensh ip
EDUCATION
Language Proficiency
Write language name and then circle or fill color in options
S S S S
R R R R
W W W W
F F F F
H H H H
S (Speak) R (Read) W (Write) F (First Language) H (Spoken at Home)
General Education
Indicate your School Name, Grade and Year orCif you currently study there
School Name: From (MM/YYYY/GG) School Name: From (MM/YYYY/GG) School Name: From (MM/YYYY/GG)
To To
(MM/YYYY/GG) or (C) (MM/YYYY/GG) or (C)
To (MM/YYYY/GG) or (C) Graduation Date
University Education
Indicate your University / College Name, Faculty and Degree and Dates attended orCif you currently study there
University / College Name: Faculty Name: Fro (MM/YYYY) m: University / College Name: Faculty Name: Fro (MM/YYYY) m:
Degre e: T o
Bachelor / Master / Phd
(MM/YYYY) or (C)
Degre e: T o
Bachelor / Master / Phd
(MM/YYYY) or (C)
Other Courses
Center Name: Course Name: Fro (MM/YYYY) m: Center Name: Course Name: Fro (MM/YYYY) m: Center Name: Course Name: Fro (MM/YYYY) m:
Proof: T o
Bachelor / Master / Phd
(MM/YYYY) or (C)
Proof: T o
Bachelor / Master / Phd
(MM/YYYY) or (C)
Proof: T o
Bachelor / Master / Phd
(MM/YYYY) or (C)
EXPERIENCE
Extracurricular Activities
Activit y: Position Held: Activit y: Position Held: Activit y: Position Held: Activit y: Position Held: Approx. Time Spent:
# Day / Wk. / Yr.
Approx. Time Spent:
# Day / Wk. / Yr.
Approx. Time Spent:
# Day / Wk. / Yr.
Approx. Time Spent:
# Day / Wk. / Yr.
Work Experience
Company/Organiz ation: Positio n: Company/Organiz ation: Positio n: Company/Organiz ation: Positio n: Company/Organiz ation: Positio n:
From
MM/YYYY
To
MM/YYYY
From
MM/YYYY
To
MM/YYYY
From
MM/YYYY
To
MM/YYYY
From
MM/YYYY
To
MM/YYYY
ACHIEVEMENTS & HONORS
PERSONAL
Religion (Optional)
Academic Interests: Career Interests: Hobbies Phobias
Do you smoke? (Optional)
2 favorite colors: 3 Words which describe you 3 Words which absolutely NOT describe you
Are you Experienced with working with a club or group, and what was your role in most cases?
How tolerant person are you?
Are you last minute kind of person? If yes, give some example briefly
How do you imagine, what is fx club for you?
Why this club and what do you expect from fx?
Please write an essay of 150-300 words on a topic of your choice:
1. Indicate a person who has had a significant influence on you, and describe that influence. 2. Describe a character in fiction, a historical figure or creative work (art, music, science) that has had an influence on you and explain that influence. 3. Topic of your choice. (Free Essay) Ready? Go!
Title Here