Fulbright Academy - Youg Professionals Tour to Libya

Please fill in this form if you would like to participate in the Fulbright Academy's August 18-22, 2010 Tour to Libya. The FAST Young Professionals tour is done in conjunction with the opening of the United Nations “International Year of Youth: Dialogue and Mutual Understanding,”
http://social.un.org/youthyear/

For those who are selected, their travel, hotel and other costs will be covered by organizations in Libya.

FAST is seeking nominations and self-nominations from Fulbrighters who are 22-40 years old and living in the following countries: United States or Europe (in particular Belgium, Czech Republic, Denmark, France, Germany, Hungary, Ireland, Italy, Poland, Norway, Sweden, and the UK).

We are accepting nominations from all fields, but are particularly interested in current grantees who are leaders of university student associations.

Please fill out the information below and be prepared to send a copy of your passport to FAST by fax or email if your nomination is accepted. Decisions will be made by July 23, 2010.

Last Name: (Required)

First Name

Dr./Mr./Ms./Mrs.

Current Position:

University or Employer:

Residential Address:

Residential City, State:

Postal code:

Country:

Nationality (if different):

Phone number (with country code) (Required)

Your fax number:

Your email address: (Required)

Fulbright: Year & Host Institution & Location:

Discipline (chemistry, business, etc):

Brief Bio:

Goals for Participation: Why do you want to go? How will your participation help you, help Libya, and/or help the Fulbright Alumni community and the Fulbright Academy of Science & Technology.

If you wish to give a reference, you may list his/her name(s) here, along with phone number or email address.

Birthday. MM/DD/YYYY

Selections will be made to assure broad representation by geography and discipline / subject area. Priority will also be given to individuals who are dues-paying members of the Fulbright Academy. Information about joining can be found at www.FulbrightAcademy.org.

Please note that the Fulbright Academy is not affiliated with the US Department of State, the Fulbright Exchange Program, or any of the Fulbright Commissions.

For more information, please send an email to ehoward@FulbrightAcademy.org.

For more information about FAST's work in North Africa, please visit:
http://www.fulbrightacademy.org/page/scidiplomacy/


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