and inform you about upcoming alumni events.
The form should be completed in English.
| 1. Today’s Date
|
| Month Day Year
|
| 2. Personal Information:
|
| Last Name:
|
| First Name:
| Middle Name:
|
| Name at Time of Application to FLEX:
|
| Date of Birth:
Month Day Year
| Year of Return from FLEX:
|
| Programs in which you have participated in addition to FLEX (circle all that apply):
LEAP UGRAD TEA PIE MUSKIE MUSKIE PhD Fulbright RSEP JFDP Other
|
|
Program Start Year and End Year:
|
| 3. Contact information where we can best reach you:
|
| Country:
| Postal Code:
|
| Region:
| City:
|
| Street Address:
| This address is your (circle one):
Home Work Other: ____________
|
| Preferred Phone (Country & city code & Number):
| This phone is (circle one):
Home Cell Work Other: ____________
|
| Mobile Phone (Code & Number):
| Home phone (Code & Number):
|
| Other Phone (Code & Number):
| Fax (Code & Number):
|
| Preferred Email Address:
| Other Email Address:
|
| 4. Alternate Contact (person who will know how to reach you):
|
| Last Name:
| Relationship to You:
|
| First Name:
| Middle Name:
|
| Country:
| Postal Code:
|
| Region:
| City:
|
| Street Address:
| Email Address:
|
| Preferred Phone (Code & Number):
| Other Phone (Code & Number):
|
| 5. Education after completing the program:
|
| Name of Institution:
| Country/ City:
|
| Department:
| Year of:
Entry: Graduation:
|
| Field of Study (please, select one):
1. Accounting and Audit
2. Advertising
3. Agriculture and Forestry
4. Anthropology
5. Archaeology
6. Architecture
7. Area/ Regional Studies: (select one)
- African Studies
- American Studies
- Asian Studies
- European Studies
- Middle Eastern Studies
8. Art History
9. Automobile Industry
10. Aviation
11. Banking and Finance
12. Biochemistry
13. Biology
14. Building and Construction
15. Business Administration
16. Chemistry
17. Computer Science and Programming
18. Conflict Resolution
19. Cross-cultural Communications
20. Design
| 21. Diplomacy
22. Economics
23. Education: Curriculum/ Policy/ Special Needs
24. Engineering and Electronics
25. Entrepreneurship and Commerce
26. Environmental Studies
27. Ethnic studies
28. Finance and Credit
29. Foreign Languages
Specify - _____________________________
30. Gender Studies
31. Geography
32. History
33. HR Management
34. Human Rights
35. Insurance
36. International Relations
37. Investment and Credit Analysis
38. IT
39. Journalism, Media and Communication
40. Law
41. Library and Museum Studies
42. Linguistics and Intercultural Communication
43. Literary Studies and Creative Writing
44. Management
| 45. Marketing
46. Mathematics
47. Medicine/ Surgery/ Pharmacy/ Veterinary
48. Military Sciences
49. Oil and Gas Technologies
50. Performing Arts: Music, Dance, Theatre
51. Philology
52. Philosophy
53. Physics and Astronomy
54. Political Science
55. PR
56. Psychology
57. Public Administration
58. Religious Studies
59. Social Work
60. Sociology
61. Statistics
62. Taxation
63. Teaching
Specify: ______________________________
64. Television, Film and Animation
65. Tourism and Hotel Business
66. Translation and Interpretation
67. Visual Arts: Painting, Photography, Sculpture
68. World Economics
69. World Politics
70. Other: _______________________________
|
| Specify your subject of studies:
|
| Degree: Bachelor’s Master’s PhD Other
| Honors or Awards:
|
| 6. Primary Employment:
|
| Company Name:
| Title:
|
| Professional Field/ Industry (please, select one):
1. Accounting
2. Agriculture/ Mining
3. Architecture/ Design
4. Arts/ Entertainment
5. Automotive
6. Computers/ Software/ Technology
7. Construction/ Engineering
8. Consulting
9. Education/ Teaching
10. Energy/ Utilities/ Fuel/ Chemicals
11. Finance/ Banking
| 12. Government/ Social Services
13. Health Care/ Hospitals
14. Human Resources/ Recruiting
15. Import/ Export/ Trade/ Wholesale
16. Information Management/ Library
17. Insurance
18. International Relations/ Diplomatic Services
19. Legal
20. Manufacturing
21. Marketing/ Advertising/ Communications/ PR
22. Media/ Publishing/ Broadcasting
| 23. Military/ Defense
24. NGOs/ Non-profit Organizations
25. Pharmaceuticals/ Biotech
26. Political Science
27. Real estate/ Property Management
28. Research & Development
29. Retail
30. Telecommunications
31. Translation/ Interpreting
32. Transportation/ Logistics
33. Travel/ Tourism business
34. Other: _______________________________
|
| Country/ Postal Code:
| Region/ City:
|
| Street Address:
| Email Address:
|
| Work Phone (Code & Number):
| Work Fax (Code & Number):
|
| Web Site:
| Start Date:
Month Year
|
| 7. Signature:
|
| Signature:
|
| For Office Use Only:
Received: ________________ FAS Entered: _________________
|
| | | | | |
