TOEFL® Scholar Program
Scholarship Application for China
ETS, located in Princeton, New Jersey, USA (ETS Princeton), has developed a scholarship program to recognize outstanding students in China who will begin their
overseas studies in 2010. The program will recognize students with high academic achievement who have demonstrated leadership skills, innovative ideas and an
outstanding ability to communicate in English. Your answers to these questions will be used only in connection with your application for the program and will be
reviewed independently by one admissions officer from an overseas institution and one Chinese professor, as well as by ETS China (a subsidiary company of ETS
Princeton that is processing applications).
All responses must be provided in English. Please TYPE or PRINT LEGIBLY. You may attach additional pages as necessary. The completeness, neatness and legibility
of your replies will allow for a complete and comprehensive review of your credentials.
ZAPPLICANT INFORMATIONZ
LEGAL NAME
Last/Family Name
First/Given Name
FULL POSTAL ADDRESS
City
Province
Postal Code
LANDLINE TELEPHONE NUMBER (RESIDENCE)
MOBILE TELEPHONE NUMBER
E-MAIL ADDRESS
GENDER
DATE OF BIRTH
Female
Male
/
Day
®
/
Month
Year
ZTOEFL TEST DETAILSZ
Total Score:
Reading:
/
Test Date:
Day
/
Month
Year
Listening:
Test Center Code:
Speaking:
Last seven (7) digits of your
TOEFL Registration Number:
Writing:
ETS ID Number:
ZSTUDY ABROAD PLANSZ
What level of academic study are you pursuing?
In which country will you
pursue your studies?
(Check all that apply)
Undergraduate
Postgraduate
/
When do you plan to begin your study abroad?
United Kingdom
Canada
United States
Other – please specify: _______________________
Month
/
What is your anticipated graduation date?
Month
Please briefly explain why you have chosen to study in the country/countries indicated above.
~1~
Year
Year
List all institutions to which you have applied, your intended course of study, and your most current application status.
These institutions must be official TOEFL Destinations. Visit www.ets.org/toefl for a list of TOEFL Destinations.
Note:
If you are selected as a scholarship winner, you will be required to provide an acceptance letter from an official TOEFL Destination by 15 May 2010. Scholarship
awards will be disbursed from ETS Princeton to winners' attending institutions after their student visas have been approved and they have arrived at their attending
institutions.
University
Major/Course of Study
Status of Admission
ZACADEMIC EXPERIENCEZ
For applicants pursuing undergraduate study, please provide high school details below, and attach official copies of certificates and transcripts.
Average Score
(on a 100-point scale)
Institution
Dates Attended
From
To
For applicants pursuing postgraduate study, please provide undergraduate details below, and attach official copies of certificates and transcripts.
Average Score
(on a 100-point scale)
Institution
Degree Granted
Dates Attended
From
To
Major(s)
ZHONORS & AWARDSZ
Please list all academic honors and awards you have earned in the past three years, along with the supporting details requested below. Please attach copies of each award or honor
received.
Name of Award or Honor
Granting Organization/Institution
Type
Academic Honor
Award
Academic Honor
Award
Academic Honor
Award
Academic Honor
Award
Academic Honor
Award
Academic Honor
Award
Academic Honor
Award
Academic Honor
Award
Academic Honor
Award
~2~
Date Received
ZWORK EXPERIENCEZ
Please provide employment details for the past three years (if you are working or have worked).
Position & Responsibilities
Organization/Institution
Dates Employed
From
To
ZPERSONAL STATEMENTZ
Apart from your academic achievement, please describe some extracurricular activities or volunteer programs in which you have participated during the last three years. Explain why
they were rewarding for you.
~3~
ZESSAY QUESTIONZ
Please describe how preparing for and taking the TOEFL test has helped you improve your "communicative English" ability and prepared you for academic and career success.
~4~
ZTERMS & CONDITIONSZ
•
•
•
All information provided in your application and associated documents submitted to the TOEFL Scholar Program must be accurate and truthful, not misleading, and not
misrepresent or omit any facts that are relevant. If ETS finds significant errors or omissions in the information you have supplied to us in the course of your application, or
that you have not met all of the eligibility requirements set forth by ETS, ETS may decide not to offer you a scholarship, or to withdraw or terminate a scholarship if it has
been awarded.
You must provide ETS with relevant information when you apply for the TOEFL Scholar Program if there is anything that may be an impediment to securing a visa or entry
clearance to study in the desired country of study (such as previous convictions or associations with terrorist organizations). If for any reason you cannot obtain a visa,
ETS may withdraw the offer of a scholarship. You should not make commitments, especially commitments with financial consequences, unless you are certain that there
will be no impediment to you securing a visa or entry clearance to study.
ETS reserves the right to withdraw the offer of any scholarship award if in its sole determination it believes that the circumstances are such that this is in the best interests
of the applicant or ETS.
ZAUTHORIZATION/CERTIFICATIONZ
Please review your responses and sign your name below.
By signing below you certify that all information contained in this application and associated documentation is accurate and true and that you explicitly consent to (and have
obtained such consent from any individual whose personal information you have included as part of this application) having the information provided in this application and
associated documentation, and as required by this application, to be used by Educational Testing Service and its third-party service providers for purposes of the TOEFL Scholar
Program, and that this information is being transferred to and processed in China. Further, by signing below, you agree to all of the conditions and requirements set forth by ETS
with regard to the TOEFL Scholar Program.
Student's Name (Please Print)
Student's Signature
Date
IF APPLICANT IS UNDER THE AGE OF 18, PARENTAL CONSENT IS REQUIRED:
Name of Parent or Legal Guardian (Please Print)
Signature of Parent or Legal Guardian
Date
How did you hear about the TOEFL Scholar Program?
IMPORTANT:
Study-abroad counselor
Poster
Flyer
Online advertisement
Online search engine
BBS posting
Magazine/newspaper article
Internet search
Family member
Friend/colleague
Other (please specify):
All required documents must be received at ETS China no later than 31 March 2010. Your application will not be considered if all
the documents are not received by this deadline. All documents must include your TOEFL Registration number and your ETS ID
number.
SUBMIT ALL REQUIRED MATERIALS TO:
ETS China
Suite 1661, Office Tower
北京市首都体育馆南路6号
Hotel Nikko New Century
北京新世纪饭店写字楼1661室
No. 6 South Capital Gym Road
100044
Haidian District, 100044
Beijing, China
If you are selected as a scholarship winner, you will be required to provide an acceptance letter from an official TOEFL Destination
by 15 May 2010. Scholarship awards will be disbursed from ETS Princeton to winners' attending institutions after their student visas
have been approved and they have arrived at their attending institutions.
E-mail questions about the TOEFL Scholar Program or application process to [email protected] or call +86-10-68313831.
ZPRIVACY STATEMENTZ
All materials submitted to support an application in the scholarship program are used only in the selection process. If you are named a scholarship winner, your folder will remain
in active status during the period that the scholarship is in force, and will be retained for one year after the application deadline. If you are not named as a scholarship winner, your
folder will also be retained for one year. All records are confidential and available for reference by program management staff and will be destroyed one year after the application
deadline.
Administrative services for the ETS TOEFL® Scholar Program are provided by Scholarship & Recognition Programs,
a unit of Educational Testing Service. Copyright © 2009 Educational Testing Service. All rights reserved. ETS, the ETS
logo, LISTENING. LEARNING. LEADING and TOEFL are registered trademarks of Educational Testing Service (ETS) in
the United States and other countries. 12920
~5~