1 Khalaf Ahmad Al Habtoor Scholarships Application
Academic Year 2018 - 2019
1. Personal Data
Name:
Address:
City/Markaz: District/Sub-district:
Governorate: P.O.Box:
Phone Number: Mobile Number:
Date and Place of Birth: Nationality:
National ID Number: Passport Number, if any:
Do you suffer from any chronic disease?
If YES, please explain.
Number of Brothers: Number of Sisters:
Email: Sex: Female Male
Emergency Contact Person:
Degree of Kinship: Mobile Number:
2. Family Data
Father’s Name:
Occupation: Foundation/Company:
Work Address:
Office Phone Number: Mobile Number:
Email: Fax Number:
Mother’s Name:
Occupation: Foundation/Company:
Work Address:
Office Phone Number: Mobile Number:
Email: Fax Number:
2 3. Education
Basic and Secondary Education:
Preparatory School: Secondary School:
Section Science Arts
Result of Second Secondary Class – Percentage: Grade in English language:
Email: Fax Number:
Which major or discipline would you like to study at AUC?
NO
YES Have you completed an English test in the period from September 2016 to present?
If the answer is YES, specify: TOEFL (iBT or ITP), IELTS, or any other tests.
Test Test Date Score
4. Activities, Personal Interests and Voluntary Activities
Mention all the extra-curricular activities, hobbies and voluntary activities in which you participated; awarded prizes or certificates; or any outstanding and concrete accomplishments in these activities. Start with the most recent activities. If need arises for an additional sheet, please attach to the application form.
When were you awarded the prize?
Why were you awarded the prize?
Average number of participation hours per week When did
you start practicing the activity?
Number of years of practice of the activity Activities/ awarded prize (if any)
5 . Explain the underlying reasons for your interest in the Khalaf Ahmad Al Habtoor Scholarships Program?
What are your expectations?
3 6. In no more than 300 words, write about a critical issue/problem that impacts any of the population sectors in your governorate. Analyze the causes of this problem, and provide your insight on how to surmount the said problem. Please write the essay on a separate sheet in clear longhand or a printed copy, and attach thereof to the form.
7. Have you ever joined a cultural exchange program?
NO YES
If the answer is YES, please indicate the program name and the year in which you attended?
Please attach the relevant certificate.
8. How did you learn about the program?
Newspaper or magazine advertisements Friends
Visual or non-visual broadcasts (TV-Radio) Non-governmental organizations ( NGOs)
Information seminars Social networks
School
Other entities
9. Do you have any relatives who graduated from or are currently enrolled at AUC?
YES NO
If the answer is YES, please explain:
Full Name Degree of Kinship GPA Graduation Year
4 10. Acknowledgment
I hereby acknowledge that I have personally completed this form without any assistance. I confirm that all the information presented herein is valid and real. I am also aware that the AUC staff is entitled to validate all the information set forth in the form and the annexed certificates and that any incorrect or incomplete information may result in exclusion from the competition or dismissal from the Empower Program.
Applicant’s Signature in English: Date:
:ﺦﯾرﺎﺘﻟا :ﺔﯿﺑﺮﻌﻟا ﺔﻐﻠﻟﺎﺑ مﺪﻘﺘﻤﻟا ﻊﯿﻗﻮﺗ
:ﺦﯾرﺎﺘﻟا :ﺮﻣﻷا ﻲﻟو ﻊﯿﻗﻮﺗ
For office use only
Reviewer’s Signature: Date:
Required certificates/documents
the box opposite the document:
To confirm attachment of the required papers, please check *
AUC financial aid form
http://www.aucegypt.edu/admissions/scholarships/vacant/khalaf-ahmed-al-habtoor Copy of birth certificate
Letter from the education department on the type of school where the applicant is enrolled (government, private or experimental)
Official excerpt of the third secondary grades once the thanawiya amma result is announced.
Copies of certificates of extra-curricular activities.
IELTS test results.
Copies of third preparatory, first and second secondary certificates.
Please send the required documents using registered mail with acknowledged receipt or by hand to the following address:
The American University in Cairo (Financial Affairs and Scholarships Office - Campus Center P024) AUC Avenue, P.O.Box 74
New Cairo 11835, Egypt tel 20.2.2615.1483 [email protected]
N.B. The program administration shall only contact those who are nominated for the personal interview in July 2018.
Deadline for submission of the required documents is June 7 , 2018
