**2008 INTERNATIONAL FULBRIGHT**![](media/image1.wmf){width="1.3in"
height="1.1583333333333334in"}

**SCIENCE AND TECHNOLOGY AWARD**

**FOR OUTSTANDING FOREIGN STUDENTS**

**For Ph.D.'s in Science, Technology and Engineering**

**[Instructions:]{.underline}**

\- Applications must be complete. If a question does not apply, please
write N/A. **Incomplete applications will not be accepted.**

\- Applications will be accepted only from Costa Rican citizens and
permanent legal residents. Those holding a U.S. passport, born in the
U.S. or whose mother, father or both are U.S. citizens do not qualify.

A complete application consists of:

\- All eleven pages of this form;

\- **[Complete official transcripts]{.underline}** showing all courses
taken and grades earned (subsequent to secondary school); **partial
academic records showing only the "approved" courses, are not
acceptable;**

\- Copies of degrees and honors earned (subsequent to secondary school).
Only applicants who have completed at least a university bachelor's
degree will be considered; in some areas, the licenciatura degree will
be required;

\- Documentation of English proficiency (results of TOEFL or TOEIC).
Only applicants who can demonstrate fluency in English will be
considered;

\- Three letters of recommendation must accompany this application;

\- Applications must be **TYPED**;

\- **[Original plus two copies]{.underline}** of applications and all
attachments are REQUIRED. Applications without the copies will NOT be
accepted.

NOTE:

\- Original and copies MUST be presented in the fashion and order
requested above. Failure to comply with this item will end in refusal of
the application.

\- Applications and documents **[will not]{.underline}** be returned to
non-selected applicants.

\- Eligible fields include: aeronautics and aeronautical engineering,
astronomy/planetary sciences, biology, biomedical engineering,
chemistry, computer sciences, energy, engineering (electrical, chemical,
civil, mechanical, ocean and petroleum), environmental
sciences/engineering, geology/earth and atmospheric sciences,
information sciences/ engineering, materials sciences/engineering,
mathematics, neuroscience/brain and cognitive sciences, oceanography and
physics.

**Field of
Study\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Date of
Application\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**I. PERSONAL DATA**

Complete Name:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

First family name Second family name Name

Date of Birth: Month\_\_\_\_\_\_Day\_\_\_\_\_\_Year\_\_\_\_\_\_
Age:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Country of Birth: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Province:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Cedula
No.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[SEX:]{.underline} [Marital Status:]{.underline} [Number of
Children]{.underline} [Citizenship:]{.underline}

\_\_\_\_\_ Male Married \_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_ Female Single \_\_\_\_\_\_

Other \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**PERSONAL DATA, CONTINUED**

Permanent Street Address: Post Office Box:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
City
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Telephone and fax where you can be reached:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Home \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Cel
phone\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Office
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

e-mail
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Message
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Father: Mother:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1st. family name 2nd. family name Name 1st. family name 2nd. family name
Name

Cedula Number
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Cedula Number
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Citizenship
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Citizenship\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Present Occupation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Present
Occupation\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

If retired, indicate last occupation If retired, indicate last
occupation

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Spouse:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Cedula
Number\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Birth
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Number of Children
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Citizenship\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Occupation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Person(s) to notify in case of emergency:**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Relationship
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1st. family name 2nd. family name Name

Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Telephones
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Relationship
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1st. family name 2nd. family name Name

Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Telephones
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2. WORK EXPERIENCE**

Do you work: Full time? \_\_\_\_\_\_ Half time? \_\_\_\_\_\_ 1/4 time?
\_\_\_\_\_\_

Do you attend school and work at the same time?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Present Employer:**

Name of firm or institution
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name and position of immediate
supervisor\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Exact title of your position
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date you began this employment
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

The institution for which you work is (please mark one) :

Private for profit Mixed public/private

Private not for profit Voluntary

Public, government entity

Total years with the same employer
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Number of employees you supervise
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Brief description of your duties**

**WORK EXPERIENCE, CONTINUED**

**Previous Employer:**

Name of firm or institution
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name and position of immediate supervisor
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Exact title of your position
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date you began this employment
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date you left this employment
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

The institution for which you worked was (please mark one) :

Private for profit Mixed public/private

Private not for profit Voluntary

Public, government entity

Total years with the same employer
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Number of employees you supervise
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Brief description of your duties**

**3. EDUCATIONAL BACKGROUND**

Are you currently enrolled in any institution of higher education?

Yes No If yes, please give name and address.

Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
City
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Province\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Complete Education Background**

Please list in chronological order all educational institutions attended
from primary school to present.

+-------------+-------------+-------------+-------------+-------------+
| **[Name     | **[Field    | *           | **[Degree   | **[Date]{.u |
| of]{.u      | of]{.u      | *[Dates]{.u | or]{.u      | nderline}** |
| nderline}** | nderline}** | nderline}** | nderline}** |             |
|             |             |             |             | **[R        |
| **[Inst     | *           | **[From]{.u | **[Cert     | eceived]{.u |
| itution]{.u | *[Study]{.u | nderline}** | ificate]{.u | nderline}** |
| nderline}** | nderline}** | **[To]{.u   | nderline}** |             |
|             |             | nderline}** |             |             |
+-------------+-------------+-------------+-------------+-------------+
|             |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
|             |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
|             |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
|             |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
|             |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
|             |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
|             |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+

The highest degree you received was (check one):

University bachelor Masters degree

Licenciatura Doctorate

Other (specify)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Grade point average in all university studies
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Please do not convert your grade point average to the U.S. system
unless you obtained a degree in the U.S. All courses -- even those
failed -- must be taken into account)

**EDUCATIONAL BACKGROUND, CONTINUED**

Have you taken any of the following tests? Please indicate yes or no
and the score received the last time you took the test.

TOEFL Score \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date exam taken
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

GRE Score \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date exam taken
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SAT Score \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date exam taken
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

GMAT Score \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date exam taken
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TOEIC Score \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date exam taken
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Have you studied outside Costa Rica under a student exchange or
scholarship program? Please Indicate

  --------------------------- ------------------------ -------------------------------------
  **[Country]{.underline}**   **[Date]{.underline}**   **[Exact name of
                                                       exchange/scholarship]{.underline}**

                                                       

                                                       

                                                       
  --------------------------- ------------------------ -------------------------------------

**4. DESIRED TRAINING**

In the space provided below please describe the kind of training you
wish to receive if you are granted a scholarship. Also indicate how you
would apply these skills upon your return to Costa Rica.

**DESIRED TRAINING, CONTINUED**

Which universities or colleges in the U.S. would you prefer if you were
granted the scholarship? If possible, tell which specific programs or
departments within these institutions have the training you seek.
(Please note that students who receive scholarships are not necessarily
placed in institutions which they name as their preferences).

**6. AGREEMENT**

In the event that I receive a scholarship to study in the United States
under the Fulbright Program, I agree to abide the rules and regulations
of that program.

I understand that:

> 1\. Upon completion of the course of studies financed by the
> scholarship, or upon being notified that the scholarship has
> terminated, **I agree to return and reside in Costa Rica for at least
> 24 months**.
>
> 2\. It is my responsibility to fulfill the academic requirements of
> the institution where I undertake my studies, and that if I do not
> fulfill those requirements the scholarship will no longer be in
> effect.
>
> 3\. The Fulbright Program does not provide funds for the maintenance
> of dependents of its scholarship grantees. I understand that I am
> responsible for all expenses related to such dependents (travel,
> school expenses, room and board, etc.)
>
> 4\. The Fulbright Program provides only basic medical insurance for
> the grantee. Any additional medical insurance whether for myself or my
> dependents is my responsibility.

I certify that:

> 1\. I have reviewed the statements I have made in this application,
> and that they are true, complete and presented in good faith.
>
> 2\. The academic records attached to this application reflect all the
> courses I have taken at institutions of higher education, and all the
> grades I have received.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of applicant (type)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_

Signature of applicant Date

**[INSTRUCTIONS TO APPLY FOR THE]{.underline}**

**[FULBRIGHT GRADUATE PROGRAM]{.underline}**

1\. Before you start preparing the application form and the documents
required, please read all the instructions, requirements and information
about the Fulbright Graduate Scholarship Program.

2\. Each applicant must present a **[COMPLETED ORIGINAL IN
ENGLISH]{.underline}** (application and all documents required) and
**[TWO COPIES]{.underline}** of the original application and supporting
documents. The three sets **[MUST]{.underline}** be stapled separately.
Disorganized sets will be immediately **[REJECTED]{.underline}**.

3\. Applicants must be Costa Ricans or legal, permanent residents. Costa
Ricans born in the U.S., U.S. citizens, Costa Ricans bearing green cards
(U.S. residency permits), or the children of U.S. father, mother or
both, cannot be taken into consideration.

4\. Applicants must have **[completed]{.underline}**, at least, a
bachelor's degree that makes him/her eligible to pursue graduate studies
in one of the designated fields approved by the Program. A higher
academic degree might be requested for some fields.

5\. Candidates must have full command of the English language. A valid
TOEFL score or TOEIC will be required as part of the documentation
needed to complete this application form.

6\. Candidates who have studied in the U.S. during the last four years,
and /or former grantees of the U.S. Government Scholarship Programs,
will [not]{.underline} be considered.

7\. The candidate\'s field of study must be within the disciplines
aeronautics and aeronautical engineering, astronomy/planetary sciences,
biology, biomedical engineering, chemistry, computer sciences, energy,
engineering (electrical, chemical, civil, mechanical, ocean and
petroleum), environmental sciences/engineering, geology/earth and
atmospheric sciences, information sciences/ engineering, materials
sciences/engineering, mathematics, neuroscience/brain and cognitive
sciences, oceanography and physics.

8\. Complete academic records will be required (reflecting
[all]{.underline} the courses taken, whether completed or dropped and
from all universities or colleges attended). [No partial]{.underline}
academic records (showing approved courses, only) will be accepted.

9\. Applicants must read and accept all the conditions listed on page 10
of the application form, **[and then sign the form]{.underline}**.

10\. **Those who are selected as grantees of the Fulbright Scholarship
must commit to return and reside in Costa Rica for at least 24 months
after completion of their program**.

11\. The last day to present all documentation required at the U.S.
Embassy, Wednesday, May 2, 2007.