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A Fulbright ETA Request Form

Please submit the completed request form to our English language program specialist Zulfiya Shirinova at ShirinovaZK@state.gov by February 28, 2015.

In the subject line please indicate the name of the program

“Fulbright ETA 2015-16” and your institution.



CONTACT INFORMATION
Name of institution/department making the request:
Name of main program contact at the institution:
Email address:

Mobile phone number:
PROJECT DESCRIPTION/JUSTIFICATION
Briefly explain why having an ETA is important for your institution?
PROJECT SPECIFICS



  1. Which department will an ETA will assigned to?




  1. What will an ETA be expected to do in addition to teaching responsibilities? (conversation/book/drama clubs, assist w/project work, etc.)




  1. How many participants do you expect?



  1. What equipment will be available for an ETA? Please check.

Overhead projector

Power point capabilities

Computers

Internet connection

Flip chart

White board

Copier for handouts



Other


  1. What materials will you provide to assist an ETA in preparing for the sessions? (e.g. program curriculum, course objectives, teaching materials, etc.)




  1. Please add other essential details.


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