THE SCRIPPS HOWARD FOUNDATION

SEMESTER IN WASHINGTON

Date: ___________________

Country: ___________________

I. PERSONAL:

Last name:_____________________________ First name: ______________________ Mr. or Ms. _____

Address: ______________________________________________________________________

_____________________________________________________________________________

Phone: ___________________________ Fax: ________________________ E-Mail: ______________________

Passport Number: ________________ Citizenship: ______________ Date of birth: ____________________

How did you find out about this program? ________________________________________________________

II. EDUCATION

Name of University:__________________________________________________________________________

Expected graduation date: _____________________ Major subject(s): ________________________________

Briefly describe your university education, especially journalism or communications classes:______________

____________________________________________________________________________________________

III. EMPLOYMENT EXPERIENCE

Current job (if any): ___________________________ How long have you held your current job? _________

Please describe your work history, especially any jobs in journalism or communications:_______________

____________________________________________________________________________________________

IV. ENGLISH LANGUAGE PROFICIENCY

Please list any English courses you have taken and certificates earned: _________________________________

____________________________________________________________________________________________

English proficiency: Other languages:

Listening: “ Excellent “ Good “ Fair “ Poor Native: ____________________________

Speaking: “ Excellent “ Good “ Fair “ Poor Other: ____________________________

Reading: “ Excellent “ Good “ Fair “ Poor 2. ____________________________

Writing: “ Excellent “ Good “ Fair “ Poor 3. ____________________________

NOTE: You are required to arrange an interview with a native English speaker in your country, who must complete the English-Language Evaluation Form of this application.

V. INTERNATIONAL EXPERIENCE

Please describe any overseas education or work, including all previous travel to the United States: _________

____________________________________________________________________________________________

VI. ESSAY - Professional Goals and Interests

On a separate page, explain why you want to participate in this program, what you hope to accomplish and what you plan to do when you finish your degree. Essay should be no longer than 700 words.

VI. SUPPORTING MATERIALS

Please ask two people who know you well (professors, employers, etc.) to send letters of recommendation to the address below. These letters must be sent separately by the person who wrote the letter. You may also send transcripts and samples of articles you have written. Letters of recommendation, transcripts and articles may be in English, Spanish, Portuguese or French.

If you have questions please contact: Katherine Wagenblass, Program Officer

International Center for Journalists Ž 1616 H Street, N.W. Ž Washington, DC, 20006

Tel: 202/737-3700 Ž Fax: 202/737-0530 Ž E-Mail: kwagenblass@icfj.org

THE SCRIPPS HOWARD FOUNDATION

SEMESTER IN WASHINGTON

ENGLISH-LANGUAGE EVALUATION FORM

(To be completed by a native English speaker)

APPLICANT=S NAME: __________________________________________________DATE: ____________

Please candidly assess the applicant=s English-language proficiency according to the following scale, by circling the appropriate number: (1) Poor; (2) Below Average; (3) Average; (4) Good; (5) Very Good; (6) Excellent. If available, please include a TOEFL score as well.

How would you rate the applicant=s ability to understand English spoken by a native English speaker?

1 2 3 4 5 6

How would you rate the applicant=s pronunciation of English?

1 2 3 4 5 6

How would you rate the applicant=s use of English grammar and syntax?

1 2 3 4 5 6

How would you rate the applicant=s English reading ability?

1 2 3 4 5 6

How would you evaluate the applicant=s overall knowledge of English?

1 2 3 4 5 6

NAME OF EVALUATOR (please print): _________________________________________________________

POSITION: ________________________ EMPLOYER: ___________________________________________

TEL: ______________________ FAX: ______________________ E-MAIL: _________________________

COMMENTS: ____________________________________________________________________________________________

____________________________________________________________________________________________

SIGNATURE: ____________________________

If you have questions please contact: Katherine Wagenblass, Program Officer

International Center for Journalists Ž 1616 H Street, NW Ž Washington, DC, 20006

Tel: 202/737-3700 Ž Fax: 202/737-0530 Ž E-Mail: kwagenblass@icfj.org

THE SCRIPPS HOWARD FOUNDATION

SEMESTER IN WASHINGTON

AGREEMENT TO PROGRAM CONDITIONS

APPLICANT=S STATEMENT

I, the undersigned, understand and agree to the following conditions of the 2008 Scripps Howard Foundation Semester in Washington:

Ø If chosen to be a participant, I will be required to spend 10 to 14 weeks full-time in the United States, participating in all aspects of the internship.

Ù Spouses or dependants cannot be accommodated in the program.

Ú The organizers will pay for round-trip economy air fare to and from the United States; housing; a per day meal/living/transportation allowance; and health insurance for the duration of the program. I will assume responsibility for all incidental expenses. (The program cannot cover salary or pay honoraria.)

Û If chosen, I will be responsible for all passport and visa arrangements, and required fees.

Ü If chosen, I am required to return to my home country after the completion of the program.

Participation in this program is contingent upon my ability to meet all requirements. I certify that all statements in my application are true, to the best of my knowledge. I understand that any participant who violates these rules will be expelled from the program.

SIGNATURE: _______________________________ DATE __________________