SEASSI 2010 Application Form Application Instructions 1. Complete the SEASSI Application Form below(General Information, Personal Language, History, and Checklist of Application Materials). Please fill in all the information requested and submit on the web or mail the form to us. 2. Send by mail or e-mail your statement of research and/or career plans (suggested length: 1-2 pages, approximately 1000 words). 3. Send official transcripts from all the universities you have attended. 4. Send the $25 application fee by check or money order in U.S. dollars made payable to: SEASSI. Do not send Western Union or any other money transfers by telegram. 5. If you are applying for a FLAS fellowship, Heritage Language Fellowship, SEASSI Undergraduate Scholarship or a Tuition Fellowship, two letters of recommendation must be sent on your behalf. Letters must be on the recommender’s official letterhead stationary with the recommender’s signature over the seal of the envelope. 6. If you have any questions, feel free to contact: Mary Jo Wilson, SEASSI Program Coordinator seassi@intl-institute.wisc.edu 207 Ingraham Hall 1155 Observatory Drive Madison, WI 53706 Phone – (608) 263-1755 Fax – (608) 263-3735 *** Deadlines to Remember *** February 19, 2010 FLAS application deadline Heritage Language Award application deadline SEASSI Undergraduate Scholarship Competition application deadline April 16, 2010 Tuition Scholarship application deadline General application deadline. After April 16, 2010 we will still accept applications for classes where there are openings available, but we will not open more sections. ******************************************************************** * denotes a required field. General Information Name: * First Middle * Last Other names used (ex. maiden, former, nickname...): * Email Gender: Male Female * Are you a US citizen or Permanent Resident? Yes No If No, please specify nationality: Current Address Effective until (mm/dd/yy): * Street: * City and State: * Zip: Country (if not the U.S.): * Current Telephone #: Permanent Mailing Address Street: City and State: Zip: Country: Permanent telephone #: * Please complete either the Students or Non-students section below. Students College/University you are currently attending (or, if you are applying to graduate programs for Fall 2010, please state that below as well as what school(s) you are applying to): Current degree program (please check the box that applies): Bachelor's Master's PhD Disclipline/Major: Non-students Current Job Title: Place of Occupation: Financial Aid * Are you applying for a fellowship? Yes No If yes, what fellowships are you applying for? Please check all that apply: FLAS Heritage Language Fellowship Tuition Scholarship SEASSi Undergraduate Scholars Fellowship * Have you applied for other scholarships/awards to support your studies at SEASSI? Yes (Check all that apply below) NSEP, Undergraduate Scholarship (http://www.iie.org/programs/nsep/default.htm) CIC-FLEP (http://www.cic.uiuc.edu/programs/flep) NSEP, Graduate Fellowship (http://www.iie.org/programs/nsep/graduate/default.htm) Luce Foundation (http://www.hluce.org/3scholfm.html) Other: Please Specify Amount: No Personal Language History * Indicate the language you wish to study at SEASSI 2010: Burmese Filipino Hmong Indonesian Javanese Khmer Lao Thai Vietnamese * Indicate the level you anticipate studying at SEASSI 2010. (Note: Placement tests will be given to everyone on the first morning of classes.) First Year Second Year Third Year If you have studied this language before, please provide the following information: Institution where you studied it: Textbook(s) used: Level: Length of study: FLAS Information Form The FLAS fellowship competition is open only to students who: 1. are enrolled in a program of graduate study, or are admitted to a degree program for Fall 2010 2. are U.S. citizens or permanent residents. If you are NOT applying for the FLAS fellowship, please skip this section and go to "Checklist of Application Materials". If you are applying for the FLAS fellowship, please complete the following information. FLAS award funds cannot be released to any student who has not returned this information. 1. Specify the language course and level in which you anticipate being enrolled during SEASSI. Language: Level: 2. Field of Study: University: Degree Sought: Master's Doctorate Master/PhD If you are currently pursuing a professional program, please indicate below: Business Education Engineering Health Science Law Library Science Public Administration/Policy Social Work 3. What is your citizenship? If you are not a U.S. citizen, are you a permanent resident of the United States? Yes -- If YES, please submit a copy of one of the following proofs of residency: (1) a copy of the stamp in your passport; (2) a copy of your green card with the green card number; or, (3) a letter from the office of U.S. Citizenship and Immigration Services (formerly INS) with your green card number No, (you are not eligible to receive FLAS fund) 4. Career Goals: Elementary/Secondary Education Federal Government Foreign Government Graduate Study Higher Education International Organization in the U.S. Public Administration/Policy Social Work 5. I certify that I do not owe a refund on any Pell or Supplemental Education Opportunity Grant and/or am not in default on any National Defense Student Loan, Supplemental Loan for Students, Consolidation Loan, or Income Contingent Loan. If you have attended SEASSI previously, please give the following information: dates attended, language(s) studied, whether you received a FLAS award, tuition scholarship, or Heritage Language fellowship. Checklist of Application Materials Transcripts and letters of recommendation may be sent separately, or in one shipment with all your other application materials. Just be sure we have all your application materials submitted by the appropriate deadline. Please fill in the following list of materials that we should expect to receive from you. Application fee of $25 – all checks or money orders should be made payable to SEASSI Personal Statement of career/academic plans (approx. 1-2 pages) Transcripts All applicants to SEASSI must submit an official transcript from every college/university attended. List below the colleges and universities you have attended, and indicate your dates of attendance. If you have attended SEASSI previously, you must submit those transcripts as well. Letters of Recommendation Letters of recommendation are required only of applicants seeking fellowships. Please list the names of your recommenders below. Recommender #1: Recommender #2:

Click on image to enlarge Other SEASSI Photos Contact Us! Please direct any questions to the SEASSI Program Coordinator: Mary Jo Wilson Center for Southeast Asian Studies University of Wisconsin-Madison 207 Ingraham Hall 1155 Observatory Dr. Madison, WI 53706 phone: (608) 263-1755 fax: (608) 263-3735 email: seassi@intl-institute.wisc.edu