iEARN Pakistan Kennedy-Lugar Youth Exchange and Study (K-L YES) Program Preliminary Application 2015 - 2016
PARTICULARS OF SCHOOL: Name of School: __________________________________________________________________________________________ Address: ________________________________________________________________________________________________ ___________________ City: _______________ Province: _______________ Telephone with city code: ___________________ PARTICULARS OF STUDENT: Name: ___________________________________________________________________________________ Date of Birth: ____________________ Place of Birth: ___________________ Province:_________________ Gender: Male Female Nationality: __________________ Religion: _____________________ Recent Photograph
(Taken within the last 6 months)

Residential Address: ________________________________________________________________________ ________________________________________________________________________ Province________________________ Phone Number: _____________________________ Mobile Number: _______________________________________________ Student’s e-mail Address: ______________________________ Class in which studying at present: _______________________ Classes studied in: 2013-2014 2012-2013 2011-2012 Class: _______________________________ Percentage: ___________________________ Class: _______________________________ Percentage: ___________________________ Class: _______________________________ Percentage: ___________________________ YES NO

Have you participated /Are you participating in English Access Microscholarship Program?

If ‘Yes” write the name of Access Centre and city: __________________________________ Year _______________________ Access Centre Address: ____________________________________________________________________________________ Have you ever visited the USA? YES NO If ‘Yes’, When & Where_____________________________________ YES YES NO NO

Have you or your family applied for the USA immigration?

Have you or your family applied for immigration to any other country?

If ‘Yes’, what is the name of that country? _____________________________________________________________________ YES NO Has your sibling (brother or sister) been on K-L YES Program? If ‘Yes’ what is his/her name? ________________________________Year Participated: ________________________________ Are you a student with physical disability or a deaf and muted student? YES NO If ‘Yes” explaind the disability: ______________________________________________________________________________ PARENTS’ INFORMATION: Father’s Name: ___________________________________________________________________________________________ Father’s Occupation: ___________________________________ Designation/Position: _________________________________ Organization / Nature of Business: ___________________________________________________________________________ Complete Work / Business Address: __________________________________________________________________________ Office Telephone No: ____________________________________________ Cell No: __________________________________ Mother’s Name: __________________________________________________________________________________________ Mother’s Occupation: __________________________________ Designation/Position: _________________________________ Organization / Nature of Business: ___________________________________________________________________________ Complete Work / Business Address: __________________________________________________________________________ Office Telephone No: ____________________________________________ Cell No: __________________________________ PTO

iEARN Pakistan Kennedy-Lugar Youth Exchange and Study (K-L YES) Program

GUARDIAN’S INFORMATION (if any): Guardian’s Name: _________________________________________________________________________________________ Guardian’s Occupation: __________________________________ Designation/Position: ________________________________ Organization / Nature of Business: ___________________________________________________________________________ Complete Work / Business Address: __________________________________________________________________________ Office Telephone No: ____________________________________________ Cell No: __________________________________

_________________________ Student’s Signature

____________________________ Parent’s / Guardian’s Signature

____________________________ Signature and Seal of School Principal

DOCUMENTS REQUIRED

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Attach Photocopy of NADRA ‘BAY’ form or NADRA Birth Certificate. Attach photocopies of the school attested marks sheets of the last 3 years.

(No other document will be accepted other than NADRA)

Note: Application received without complete required documents WILL NOT be considered. Providing any false/forged documents or information at any stage of selection process will result in disqualification of the applicant.

Completed applications can be submitted to school and the school can forward them to iEARN Centre, Karachi or students can send their applications directly to iEARN Centre. iEARN CENTRE 88-H, P.E.C.H.S, Block-6, Near Madani Masjid, Karachi, Sindh, Pakistan. Phone: 021-34547547, 34547549 • • • • • Write K-L YES 2015 – 2016 on the top of the envelope Make sure you provide all correct and accurate information. If anything is found incorrect after verification the application will not be accepted. This is not the application form; the complete application form will be issued after the clearance of the English language proficiency test and final interview. The acceptance of this form does not ensure the acceptance in the K-L YES program. Visit the web http://www.iearnpk.org/yespk.htm for detailed information and updates.

iEARN Pakistan Kennedy-Lugar Youth Exchange and Study (K-L YES) Program K-L YES ELIGIBILITY CRITERIA
Students who meet the following criteria can apply using the Preliminary Applications: • • • • • • Secondary school students in their home country who are currently enrolled in 8th, 9th or 10th grade. Preferably students who have taken or will appear in grade 9th, 10th, 11th or 'O' Levels examinations by August 1, 2015 and waiting for results. Minimum 15 years of age but not more than 17 years on August 1, 2015. Minimum grade "B" (60%) in all subjects in the last class attended; overall minimum ‘B’ average (60%) for the past three years. Minimum 60% in all subjects in the last examination before departure to the U.S.A. (The annual exams that will be held in 2015). Students will be required to send the mark sheets of the last examination when they receive the mark sheets. Should not have traveled previously to the United States. Can communicate in English. Minimum "B" grade, (60%) in English during the past three years.

Students who meet the following in addition to the above criteria are likely to be short listed for the final competitions. • • • • • • • • Should pass English Language Proficiency test. Know and practice Pakistani culture and values, and able to represent the same in the U.S. schools and communities. Demonstrate maturity, flexibility, adaptability, good character and scholastic aptitude. Willingness to participate in host family’s daily life. Record of all necessary immunizations, as outlined in the Student Application, before arriving in the U.S. Should demonstrate flexibility and a commitment to promoting cross-cultural understanding. Agreement to attend classes as a full-time student and maintain at least a ‘B’ Grade average in an American high school. Willingness and agreement to abide by the 'K-L YES Student Rules' as outlined in the K-L YES Student Application and all other rules and policies during the program.

Application and Selection Process for 2015 – 2016
Students who fulfill the Selection Criteria and agree to the Parent Student Agreement and General Program Rules (Please visit the website www.iearnpk.org/yespk.htm), can apply for the scholarship. Female students, students with physical disabilities and students from non-elite and government schools who meet the criteria are strongly encouraged to apply. Students who are eligible according to the Selection Criteria but their schools are not interested in participating in the K-L YES program can apply independently. They can fill the online Preliminary Application Form on K-L YES website or download it and submit it via courier or mail along with all the required documents. Please do not send any original documents. We do not return any documents submitted. Only send the photocopies of the documents mentioned in the Preliminary Application. The participating schools/organizations must collect fully completed applications with all required documents from students and submit the applications and required documents to the iEARN office. After the initial application evaluation, the short listed candidates will be invited to take the English language proficiency test. English language proficiency test will be organized in some of the major cities of Pakistan. Keep checking the announcement section of the iEARN Pakistan website for updates and information for test dates. Students who pass the English language proficiency test would be short listed and interviewed by an ‘Interview Committee’. Students who qualify the interviews will be asked to complete and submit the final K-L YES application along with the signed program agreement and passport. After the final review and evaluation of the applications, the students who are selected as K-L YES finalists will be notified by a letter from the K-L YES Program Director. The students selected finally would be enrolled in a compulsory ‘Pre Departure Orientation’ program prior to traveling to the USA.

iEARN Centre 88-H, P.E.C.H.S, Block-6, Near Madani Masjid, Karachi, Sindh, Pakistan. Phone: 021-34547547, 34547549 E-mail: YES@iearnpk.org Web: www.iearnpk.org/yespk.htm