(Please read instructions on the reverse of last copy before completing
this form.)

<table style="width:100%;">
<colgroup>
<col style="width: 12%" />
<col style="width: 20%" />
<col style="width: 4%" />
<col style="width: 2%" />
<col style="width: 26%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 8%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="4" rowspan="2"><p>AGENCY FOR INTERNATIONAL DEVELOPMENT</p>
<h1 id="academic-enrollment-and">ACADEMIC ENROLLMENT AND</h1>
<p><strong>TERM REPORT</strong></p></td>
<td colspan="3"><p>1. NAME OF PARTICIPANT</p>
<p>     </p></td>
<td colspan="3"><p>2. DATE</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="3"><p>3. COUNTRY</p>
<p>     </p></td>
<td colspan="3"><p>4. STRATEGIC OBJECTIVE</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="3"><p>5. NAME OF INSTITUTION</p>
<p>     </p></td>
<td colspan="7"><p>6. PROGRAM OFFICER AND AGENCY</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="10"><strong>TO BE COMPLETED BY PARTICIPANT</strong></td>
</tr>
<tr class="odd">
<td colspan="3"><p>7. MAILING ADDRESS AND TELEPHONE NUMBER</p>
<p>     </p></td>
<td colspan="7"><p>8. ACADEMIC ADVISOR – NAME, TITLE, DEPARTMENT, AND
TELEPHONE NUMBER</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="10">9. TYPE OF HOUSING ACCOMMODATION: DORMITORY APARTMENT
ROOM</td>
</tr>
<tr class="odd">
<td colspan="10"><p>10. COURSES IN WHICH YOU ARE NOW ENROLLED:</p>
<p>Starting Date:       Ending Date:      </p></td>
</tr>
<tr class="even">
<td><p>COURSE</p>
<p>NUMBER</p></td>
<td colspan="7">COURSE TITLE</td>
<td><p>CREDIT</p>
<p>UNITS</p></td>
<td><p>AUDIT</p>
<p>UNITS</p></td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="7">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="7">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="7">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="7">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="7">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="7">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="10"><p>11. COURSES COMPLETED LAST TERM:</p>
<p>Starting Date:       Ending Date:      </p></td>
</tr>
<tr class="even">
<td><p>COURSE</p>
<p>NUMBER</p></td>
<td colspan="5">COURSE TITLE</td>
<td colspan="2">CREDIT UNITS</td>
<td>GRADE</td>
<td><p>AUDIT</p>
<p>UNITS</p></td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="5">     </td>
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="5">     </td>
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="5">     </td>
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="5">     </td>
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td>     </td>
<td colspan="5">     </td>
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td>     </td>
<td colspan="5">     </td>
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="10">12. TRAINING OR FIELD TRIPS AWAY FROM CAMPUS
<em>(Dates, location, purpose):</em></td>
</tr>
<tr class="even">
<td colspan="10"><strong>CUMULATIVE GPA</strong>      </td>
</tr>
<tr class="odd">
<td colspan="10">     </td>
</tr>
<tr class="even">
<td colspan="10">13. PARTICIPANT’S COMMENTS ON ACADEMIC
PROGRESS/PROBLEMS:      </td>
</tr>
<tr class="odd">
<td colspan="10">Signature of participant:
________________________________________________ Date:
____________________________</td>
</tr>
<tr class="even">
<td colspan="10"><strong>TO BE COMPLETED BY ACADEMIC
ADVISOR</strong></td>
</tr>
<tr class="odd">
<td colspan="2"><p>14. DEGREE OBJECTIVE AND MAJOR FIELD</p>
<p>     </p></td>
<td colspan="3"><p>15. EST. DATE OF DEGREE</p>
<p>COMPLETION      </p></td>
<td colspan="5"><p>16. SPECIAL STUDENT</p>
<p> UNDERGRADUATE GRADUATE</p></td>
</tr>
<tr class="even">
<td colspan="10">17. ACADEMIC ADVISOR’S COMMENTS:      </td>
</tr>
<tr class="odd">
<td colspan="10">Signature of Academic Advisor:
________________________________________________ Date:
____________________________</td>
</tr>
<tr class="even">
<td colspan="10">18. COMMENTS:      </td>
</tr>
</tbody>
</table>

AID 1380-69 (6/88)

**INSTRUCTIONS**

+-----------------------------------+-----------------------------------+
| This report is the only regular,  | courses dropped, incompletes made |
| official communication between    | up, etc.                          |
| the participant, USAID and the    |                                   |
| officials in his/her home         | BLOCKS 14: TO BE COMPLETED BY     |
| country. It gives the officials a | ACADEMIC ADVISOR.                 |
| report of the participant's       |                                   |
| performance, his/her progress     | You are requested to complete     |
| toward the training objective and | items 14 through 17 only, sign,   |
| the approximate time of           | retain the first copy and send    |
| completion.                       | three copies to the Program       |
|                                   | Officer indicated in item 6.      |
| All U.S.A.I.D. participants are   | Additional pages may be attached  |
| expected to devote full time to   | if needed.                        |
| their training program.           |                                   |
| Consistent with good programming, | **Block 14:** Enter degree, if    |
| they are expected to complete     | appropriate, and major field.     |
| their objective and return to     |                                   |
| their job immediately following   | **Block 15:** When a reasonably   |
| training.                         | accurate completion date can be   |
|                                   | determined, please indicate.      |
| It is U.S.A.I.D. policy that      |                                   |
| participants not accept           | **Block 17:** Comments on         |
| employment during their stay in   | relevant factors such as          |
| the United States. This insures   | participant's language            |
| maximum time for study and        | difficulties, scheduling          |
| attention to their program of     | difficulty, reasons for less than |
| instruction.                      | full schedule, atitude, effort,   |
|                                   | special training needs,           |
| BLOCKS 1 -- 13: TO BE COMPLETED   | leadership ability, etc.          |
| BY PARTICIPANTS.                  |                                   |
|                                   | **Block 18:** Comments by         |
| Please type this report. A copy   | OIT/RSSA/Contractor/Other.        |
| will be sent to your country and  |                                   |
| a legible, reproducible copy is   | USAID and the participant's       |
| desired.                          | government consider your comments |
|                                   | to be one of the most important   |
| You are to complete blocks 7      | sections of this report. They are |
| through 13 only, sign and submit  | interested in the courses he/she  |
| to your advisor within one week   | takes and the grades he/she       |
| after completion of final         | receives, but they are also       |
| registration.                     | concerned about his/her           |
|                                   | development. Your comments        |
| **Block 12:** Complete if you had | provide them with information     |
| training of field trips away from | about his/her ability to adjust   |
| the campus during or between      | to change, leadership, attitude,  |
| terms: schools visits,            | efforts, etc.                     |
| conferences, observation tours,   |                                   |
| practive work, etc.               |                                   |
|                                   |                                   |
| Block 13: Complete if you had     |                                   |
| difficulties that have affected   |                                   |
| your academic progress: language  |                                   |
| difficulty, low grades,           |                                   |
+-----------------------------------+-----------------------------------+

AID 1380-69 (6/88) back