Form DS-7003 Application for Teaching and Administrative Exchanges to

Fulbright Teacher Exchange Program Application Package

DS7003

Fulbright Application for Teaching and Administrative Exchanges to the United States

OMB: 1405-0114

Document [pdf]

Download: pdf | pdf

Fulbright Teacher Exchange Program International Application and Instructions
Applicants are strongly encouraged to speak with the Fulbright representative in their home country before applying to the program.
Contact information for countries that are currently participating in the Fulbright Teacher Exchange Program are available at our website:
(http://www.fulbrightexchanges.org/base/Overseas_Main.asp). Be sure that you meet eligibility requirements for the program as well as
the specific requirements. The application forms may be photocopied for interested colleagues, and applications may be submitted on
photocopied forms. However, applications must bear original signatures.
In addition to this application, your home country may have additional application requirements. Please confirm with the Fulbright
representative in your home country that you have submitted all application materials completely and properly.
Those applying for teaching and administrative exchanges should complete pages Aii - A7 of the application and sign the terms of
agreement on page A7. All forms and recommendations on the checklist plus any additional application requirements requested
by your home country must be submitted by the application deadline set by the Fulbright representative in your home country.
Mailing Address
Applications, references, related documentation, and all future communication should be sent to the Fulbright Commission and or
cooperating agency in your country. See our website (http:www.fulbrightexchanges.org/base/overseas_link.asp) for country specific
contact information.

Special Instructions:
J. William Fulbright Foreign Scholarship Form
This page, Aii, follows the Application Checklist page. It must be completed and returned along with your application. In section L, you
should provide a brief description of what you expect to gain professionally and personally from participation in the Program. This form
MUST be typed.
Application (pp. A1 to A7)
While typing is preferred, application forms may be completed in black or blue ink. If additional space is needed, enter information in Item
XIV, "Remarks," or use additional sheets. Place your name and date of birth at the top of each additional sheet, and identify the item
number to which the answer applies. Fill out the application forms completely; use additional sheets for continuation purposes only.
Do not send your résumé or simply say "see attached."
Sign page A7 and forward the original of pages Aii and A1 through A7 (and any additional sheets), along with the original of the essay to
the Fulbright Commission or cooperating agency in your country.
II. "Applicant For..." (p. A1)
Before choosing a length of exchange (year, semester, six-week, other), please check with the Fulbright Commission or cooperating
agency in your home country to verify what options are available for you.
If you answer "Yes" to Question D you will be considered for a one-way assignment should a suitable assignment become available.
One-way assignments are very rare and up to five per year across all participating countries may be available depending on funding and
interest by a particular country.
III. "Modern Foreign Language Fluency" (p. A1)
Indicate your proficiency in English first, then any languages that you speak. You will be screened for your proficiency in English.
IV. "Education and Professional Preparation Above Secondary School" (p. A2)
List only college/university level institutions in chronological order. All applicants must have a Bachelor's degree or equivalent
to be eligible for the program. If you have an equivalent degree it is helpful to provide further explanation and attach proof of
equivalency.
V. "Present Employment" (p. A2)
The approving administrative official listed under Question E must be the same as the person completing the "Administrative
Approval for Applicant" form (Page A8).
VI. "Daily Schedule for Current Year" (p. A2)
To enable accurate matching, teachers are asked to describe fully their current teaching assignments. Please write this directly on the
application, using an additional sheet for continuation purposes only.

DS-7003
xx-xxxx

Instruction page 1 of 2

VII. "Previous Experience/Employment" (p. A3)
All applicants must have at least three years of full-time teaching and/or administrative experience.
X. "School or College Information" (p. A5)
Information on the schools of applicants is critical to finding suitable matches. This section should be filled out thoughtfully and completely.
Use additional sheets if necessary.
XI. "Accommodations" (p. A5)
Please answer all questions if you wish to exchange housing. Note: Housing is a private matter between grantees in which the United
States Department of State will not become involved. For direct exchanges, teachers are expected to locate suitable housing for their
partner and vice-versa before going on exchange. Fulbright recommends the following options when making housing determinations: 1)
finding housing on your own in the open market with suggestions from your exchange partner; 2) asking your exchange partner to locate
local, in-country rental options that might meet your needs; 3) exchanging housing with your partner. The Fulbright program reserves the
right to request termination of an exchange should housing issues significantly affect how the professional exchange is conducted. Any
problems arising from a housing situation into which an individual grantee has entered are the sole responsibility of the grantee and not of
the Fulbright program.
Application (pp. A8 to A14)
Pages A8 to A14 are approval and reference forms. The applicant should complete Item 1 on each form and then give them to the
appropriate colleagues or officials. All four of these forms must be submitted with your application. These forms must be filled out
completely, and not simply signed. Include them in your application package in sealed envelopes signed across the back of the envelope
flap. If your school district requires the Administrative Approval form to be sent under separate cover, indicate this on the "Application
Checklist."
"Administrative Approval for Applicant" (p. A8)
The official who completes and signs the "Administrative Approval for Applicant" form must be the official authorized to approve
participation in the exchange, grant a leave of absence, and approve the appropriate salary arrangements. (For year and semester
programs, the "with salary" box must be checked, or the application will not be considered. For short term programs occurring
during the school year, we recommend that approval be given "with salary." If the "with salary" box is not checked, the
applicant must explain on a separate sheet how she or he will fund participation. For summer seminars "without salary" is
appropriate. For one-way assignments, either selection is appropriate) Within public school systems, administrative approval must
come from the district level or equivalent level in your country (e.g. usually the superintendent). Please discuss with your Fulbright
commission who the appropriate signer should be.
Reference Forms (pp. A10, A12 and A14)
The references should be completed and signed by individuals familiar with the applicant's professional work. One of these forms (the
"Immediate Supervisor Reference for Applicant") must be completed by the applicant's immediate supervisor or the person responsible for
the applicant's formal evaluation. The Supervisor must also provide a general description of the school on the reverse of this form. Persons
writing references should place the reference form in a sealed envelope signed across the back and clearly marked "Reference for
(applicant's name)." Sealed and signed references must be included in your application package. Applicants should not include
performance evaluations with their applications. Other commendations and awards may be listed in Item VII, Question D, on Page A3.
In general, we prefer that the entire application packet (including application, essay, references) be submitted to our office in one
complete packet when possible.
Miscellaneous
Applicants must inform the Fulbright Teacher Exchange Program in your country in writing of:
•
•
•
•
•
•

DS-7003

a change of address or phone number;
a change of plans affecting the application;
a desire to withdraw the application;
an application to teach or study abroad under another program;
a termination of teaching contract;
a change in assignment or school administration.

Instruction page 2 of 2

TEACHER EXCHANGE PROGRAM
INTERNATIONAL APPLICATION
APPLICATION SECTION

2009-2010

Application Checklist
Please complete this checklist and enclose it with your application package. Please do not staple any of your application pages
(paper clips may be used). Mail all application materials to the address listed on the Fulbright Teacher Exchange Program web-site
(www.fulbrightexchanges.org) for the Fulbright Commission or Post in your home country.
1.

Does your package include:
a. 1 Fulbright Foreign Scholarship Board (FSB) form?

Yes

b. 1 original of the application?

Yes

c. 1 original of the essay?

Yes

d. 1 "Administrative Approval for Applicant" form?*

Yes

e. 1 "Immediate Supervisor Reference for Applicant" form?*

Yes

b. Are you currently employed at the specified teaching level?

Yes
Yes

No
No

c. Are you currently employed in the specified subject field?

Yes

(The form must be typed.

f. 2 additional references?*

Are any of the above documents being sent under in a separate envelope?
If so, which ones?

Is your Administrative Approval completed by the school official authorized
to grant the required salary and leave arrangements?

Make sure you are eligible for all the positions you listed in Section II
of your application:
a. Do you have sufficient English fluency?

*All references forms submitted must include original signatures. The reference forms may be included with your application
package or mailed under separate cover. References mailed under separate cover should be submitted by your country's
application deadline.
PAPERWORK REDUCTION ACT: Public reporting burden for this collection of information is estimated to average two (2) hours
per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. This information is being collected to evaluate a candidate's
eligibility and suitability to be matched with a foreign counterpart for the Fulbright Teacher Exchange Program. Responses are
voluntary; however, insufficient applicant data could disable successful matching. A federal agency may not conduct or sponsor,
and the respondent is not required to respond to, a collection of information unless it displays a valid OMB control number. Send
documents regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to A/ISS/DIR, U.S. Department of State, Washington, DC 20520.

PRIVACY ACT STATEMENT
AUTHORITIES: The information is sought pursuant to Section 102 of the Mutual Educational and Cultural Exchange Act of 1961,
as amended (the Fulbright-Hays Act) (22 U.S.C. 2452).
PURPOSE: The information solicited on this form is necessary to evaluate a candidate's eligibility and suitability for participation in
the Fulbright Teacher Exchange Program, for general statistical use within the Department of State, and to direct program outreach
strategies in subsequent program cycles. Failure to provide the information requested on this form may result in non-selection.
ROUTINE USES: The information may be shared with overseas counterpart agencies of the Bureau of Educational and Cultural
Affairs or field personnel in selected countries to ensure matching with a foreign counterpart, and with local school authorities for
their concurrence on the exchange. The information provided may also be released to federal, state, local, or foreign government
entities for law enforcement purposes.

DS-7003
xx-xxxx

Page Ai

*OMB Approved No. 1405-0114
Expiration Date: xx/xx/xxxx
Estimated Burden: 2 Hours

J. William Fulbright Foreign Scholarship Board
Fulbright Teacher Exchange Candidate
2009-2010
Last

A. Name:
Dr.

Mr.

Mrs.

B. U.S. Citizen:

First

Middle Initial

Miss

Ms.
Yes

C. Home Telephone (area code, number)

If no, state country of citizenship

Country of residence

D. Complete Home Mailing Address (include number, street, city, zip code):

F. Indicate year and country of any previous
Fulbright grants (if none, write "none"):

E. Date of Birth (mm-dd-yyyy):
Place of Birth (city, state, country):
G. Current Occupation:
Name and address of employer

Job Title

Employed Since (mm-yyyy)

H. Current Subject(s) and level(s):

I. First Country Choice:

J. Education:
Name of institution, university, or professional school and location

Major field of study

Name of degree and date (mm-yyyy) received

K. Name your most significant publications/honors/awards/project or other accomplishments:

L. Provide a synopsis in approximately 50 words of your personal goals as related to this exchange program. The explanation of your goals will
be reviewed by the Fulbright Scholarship Board.
(Please use only this space. Additional pages will not be accepted):

FOR FSB USE ONLY:

Approve

Disapprove

Abstain

FSB Name
Signature
DS-7003
xx-xxxx

Date (mm-dd-yyyy)
Page Aii

*OMB Approved No. 1405-0114
Expiration Date: xx/xx/xxxx
Estimated Burden: 2 Hours

U.S. Department of State

APPLICATION FOR TEACHING AND ADMINISTRATOR EXCHANGES TO THE UNITED STATES
Please read all instructions before completing this form. Please type or print clearly in black ink. This form may be copied.
ID#:09

I. APPLICANT BASIC DATA
A. Title:
Dr.

Mr.

Mrs

Ms.

F. Of what country are you a citizen?

Name (Last, First, Middle):

G. Military service completed:

Miss

Yes

B. Complete Home Mailing Address
(include number, street, city, state, province, country, and postal code):

H. Disabled:
Yes
If so, please describe:

C. Home Telephone (country code, number):

I. Native Language(s):

Home Fax (country code, number):
Home E-Mail:
Cell Phone (county code, number):
D. Date of Birth (mm-dd-yyyy):

E. Have you ever applied to the program before?
If so, list all program years for which you applied and were/were not accepted
(e.g., 1989-90, 1998-99):

II. APPLICATION FOR DIRECT EXCHANGES (individual exchanges involving matched teaching and administrative
assignments)
You may check more than one box. (not all types of programs may be offered by your country)
year-long exchange

semester exchange

six week exchange

A. TEACHING POSITION:

Yes

B. DIRECT ADMINISTRATOR EXCHANGE:

Yes

other

C. OTHER PROGRAM:

D. Would you consider a one-way assignment?

Yes

E. Is your spouse applying for a position abroad through this program? (not permitted for administrator exchanges)

Yes

1. If so, will you accept a position if no position is offered to your spouse? (if applicable)

Yes

2. Are you and your spouse willing to be placed in different locations? (if applicable)

Yes

III. FOREIGN LANGUAGE FLUENCY
Language

DS-7003
xx-xxxx

Understanding
Exc.

Good

Speaking
Fair

Exc.

Good

Reading
Fair

Exc.

Good

Writing
Fair

Exc.

Good

Fair

Page A1

IV. EDUCATION AND PROFESSIONAL PREPARATION ABOVE SECONDARY SCHOOL (e.g. list university-level
(institutions) (List degrees in chronological order) (All applicants must have at least a Bachelor's Degree or equivalent degree)
Dates Attended
(mm-yyyy)

Institution, Location
From

Degrees Received
To

Major Subjects

Date
(mm-yyyy)

Kind

V. PRESENT EMPLOYMENT
A. Present Position Title:

Years at Present Position:

B. Name and Address of School
(include number, street, city, state, province, country, postal code):

Telephone (country code, number): and e-mail address:

Fax (country code, number):

C. School Principal's or appropriate University Official or Dean's Name (include Dr., Mr., Mrs., Ms., or Miss):

Telephone (country code, number) and e-mail address:

School Principal's or University Official or Dean's Job Title:

D. Immediate Supervisor's Name (include Dr., Mrs., Ms., or Miss):

Telephone (area code, number) and e-mail address:

Immediate Supervisor's Job Title:

E. Approving Administrative Official's Name (include Dr., Mr., Mrs., Ms., or Miss):
Note: Must be the official authorized to approve participation in the exchange, grant a leave of absence, and approve the appropriate
salary arrangements, e.g., President, Headmaster, Superintendent or District Official. See "Administrative Approval for Applicant" form.

Telephone (area code, number) and e-mail address:

Approving Administrative Official's Job Title:

Name and Address of Approving Administrative Official's Institution (include number, street, city, state, country, postal code):

VI. DAILY SCHEDULE FOR CURRENT YEAR (Administrator Exchange Applicants describe duties on separate sheet.)
A. Subjects: Be specific and provide details (e.g., World
History: European emphasis). Special Education teachers
are requested to include details about student needs and
teaching approaches.

DS-7003

Number of
Teaching
Hours Per
Week

Grade Level and Age of Students
Grade

Age

Number of
Students

Page A2

B. Additional Activities: Describe workload other than a
teaching position (e.g., counseling, supervision, curriculum
development extra-curricular activities).

Number of
Teaching
Hours Per
Week

Grade Level and Age of Students
Grade

Age

Number of
Students

C. What is the best time to call you at school ?
D. Have you been absent from your job more than six days per year in the last three years?
If yes, please explain:

Yes

VII. PREVIOUS EXPERIENCE/EMPLOYMENT (All applicants must have at least three years of full-time teaching
and/or administrative experience)
A. List any full-time teaching/administrative experience, beginning with the most recent:
Dates
(mm-yyyy)
Position Title
Name and Location
From
To

Full-Time Teaching Position
Grade

Subject

B. List any experiences you have had studying, working or traveling abroad:
Dates
(mm-yyyy)
From

Country

Purpose of Visit

C. List memberships in educational, professional, and civic associations:

D. List awards and publications:

VIII. OTHER EXPERIENCE
A. List extracurricular activities you can direct or sponsor (e.g., sports, arts, dramatics, music, etc.):

DS-7003

Page A3

B. List educational experiences you have had which would be especially helpful to you in working in the United States (e.g., working with
bilingual students, student exchange programs, etc.):

C. List experiences you have had in teaching English to both native and non-native speakers. This section is especially required if you
are applying as an English or English as a Second Language (ESL) teacher.

IX. U.S. GOVERNMENT EDUCATIONAL EXCHANGE GRANTS
A. Have you ever received a U.S. Government educational exchange grant ?
If yes, please indicate the year, country, type of grant and sponsoring agency.

Yes

B. If you did not accept or complete the grant, explain briefly:

DS-7003

Page A4

X. SCHOOL OR UNIVERSITY INFORMATION
A. If school is primary or secondary, is it year-round?

B. Dates of current school year terms (mm-dd-yyyy): Fall (from:
C. Number of school teaching staff:
D. School type:

Public

Number of terms:

Yes

) Spring (from:

to:

Number of faculty in department:
Private

Religious

)

Number of students in institution:

E. School location:

Urban

Suburban

Rural

F. Description of school/university (include academic level, composition of student body, teaching method, resource materials, special
features, etc.). Use additional sheet if necessary:

XI. ACCOMMODATIONS (Applicants for direct administrative exchanges need not complete this section. Teacher applicants
should fill out this section in a complete manner)
A. HOUSEHOLD MEMBERS (other than applicant):
Relationship
Code
H: Husband
W: Wife
D: Daughter
S: Son
O: Other (i.e. Domestic Partner)

Names

Dates of birth
of dependents
21 and below
(mm-dd-yyyy)

To accompany on
teaching assignment
(Check One)
Yes

B. HOUSING:
Are you willing to exchange housing?
If yes, type of accommodation

Yes
House

Number of rooms:
Housing location:

Apartment

Proximity to School (kilometers or miles-indicate which)
Other (Describe):

Number of bedrooms:
Urban

Suburban

Number of beds:
Rural

Is adequate public transportation available in the community?

Yes

Does it run between your home and your school?

Yes

Do daily tasks in your community require use of a car, e.g., grocery shopping, doctor visits, etc.?

Yes

XII. ESSAY
On no more than two additional pages, please write one essay addressing both A and B below:
A. Provide a narrative picture of yourself. The essay should deal with your personal history, focusing on influences on your intellectual
development, the educational and cultural opportunities (or lack of them) to which you have been exposed, and the ways in which these
experiences have affected you. Also include your special interests and abilities.
B. Describe your future career goals and plans, especially ways you plan to use your experience on exchange in your professional work in
home country or abroad and to enhance international education in your school/university and community.

DS-7003

Page A5

XIV. REMARKS
(Additional space for answers: Use this space to provide additional information on any item. Write the number
and letter of the item to which each answer applies. If you need more space, attach additional sheets.)

DS-7003

Page A6

TERMS OF AGREEMENT IF SELECTED
1.

I agree to reflect the ideals of my home country while observing and obeying the laws of the United States of America, the
country in which I will be exchanging.

For teacher exchange applicants: When requested, I will have a complete physical examination and will submit a physician's
"Report of Medical Examination." I will also submit a "Statement of Health for Dependents" form from a physician for all who
accompany me. All medical examinations will be at my expense. In addition, I guarantee that I and anyone accompanying me
will have comprehensive medical insurance sufficient to cover any major medical contingency that may occur in the U.S..
For administrative exchange applicants: When requested, I will submit a statement of health from a physician. I understand
that a medical examination report, completed at my expense, may be required.

I am aware that travel before a grant is awarded is not reimbursable, nor is travel (for example, home) during the exchange for
private purposes.

If required by my grant, I will travel on an airline designated for the transportation of grantees.

I will attend all orientation activities in the United States and/or in my home country/region.

If selected for a teaching assignment in the U.S., I will complete my assignment, remaining, if necessary, beyond the usual
closing date of the school system in my home country. I will return to my teaching post in my home country for the year
following my exchange year unless an extension of my leave is authorized by my school authority and the U.S. Department of
State.
If selected for a short-term assignment of eight weeks or less, I will complete it, participate in all activities, and complete all
required assignments. I will not be accompanied by dependents, relatives, or friends until the termination of the short-term
assignment.

7. I will accept no employment other than my position as an exchange teacher during my stay in the U.S., unless approved in
writing by U.S. Department of State.
8. I am aware that, should the exchange be terminated as a result of my inability to fulfill the obligations, I may be asked to
reimburse funds expended on my exchange.
9. I am aware that no one or more of the following will be liable for any claim or claims resulting from either exchange partners'
failure to enter upon or to complete the program outlined in the grant: the FSB, the United States Department of State, the
cooperating agency, and the commission or post.
10. I have had a criminal background check conducted by my institution/district at the time of my employment.
Please list date of most recent criminal background check (mm-dd-yyyy)

I certify that I have read and understand the "Terms of Agreement" and that the information provided in this application is, to the
best of my knowledge, true and correct. I am aware that a false statement may be grounds for non-selection or termination of my
exchange. I further certify that I have notified the program authorities in my country and in the U.S. of any misdemeanor (except
minor traffic violation) or felony convictions or pending indictments. My signature confirms that I will abide by the "Terms of
Agreement" if selected for program participation.

SIGNATURE OF APPLICANT
DATE (mm-dd-yyyy)
How did you first hear about the Fulbright Teacher Exchange Program?
from a colleague at my school or university

through a professional journal or other publication

from a school or university administrator

at my local library

from a former participant of this program
from a friend

through advertisements from the Fulbright program
or U.S. Embassy (mailing or website)

at a conference

other (please specify)

at the U.S. Embassy
at the Fulbright Commission

DS-7003

Page A7

TEACHER
EXCHANGE PROGRAM
REFERENCES
2009-2010

*OMB Approved No. 1405-0114
Expiration Date: xx/xx/xxxx
Estimated Burden: 2 Hours

Administrative Approval for Applicant

ID#:09

1. Name of Applicant (Last, First, Middle):
2. INSTRUCTIONS FOR APPROVING ADMINISTRATOR:
Please complete the following sections and sign this form to certify your approval or disapproval of the applicant's pursuit of an
exchange or one-way assignment through the Fulbright Teacher Exchange Program. Indicate the type of leave to be granted and
whether or not your teacher has undergone a criminal background check (You may check more than one box). (Please see reverse of
this form.)

A. APPROVAL
For Direct Exchanges (one year, one semester, short-term) and Administrator Exchanges:
The above applicant is employed full-time by our university, school or school system. The applicant has, in my judgment,
superior qualifications and will be an excellent representative of our educational system in the U.S.. If we and all other necessary
parties agree to a proposed assignment, the following leave(s) of absence will be approved and the applicant will be released
under the conditions checked below in order to accept a position under the Fulbright Teacher Exchange Program.

With salary

Without salary

Not applicable (summer program)

For One-Way Assignments:
If a one-way assignment were to become available and the above applicant were to be proposed for such an assignment
and all necessary parties agree to the proposed assignment, the following leave(s) of absence will be approved and the
applicant will be released under the conditions checked below in order to accept a position under the Fulbright Teacher
Exchange Program.

With salary

Yes

Without salary

According to institutional/district procedures, we conducted a criminal background check of the applicant at the time of his/her
employment.

B. DISAPPROVAL
The above teacher/administrator is employed by our school or school system and will not be granted a leave of absence.

C. OFFICIAL SIGNATURE
Note: This form must be completed and signed by the official who is authorized to approve participation in the exchange, grant a leave of
absence, and approve the appropriate salary arrangements for the university, school or school system in which the applicant is
employed, e.g., President, Headmaster, Superintendent or District Official or equivalent in your country.
Name and Job Title of Chief Administrator or Authorized Official (President, Headmaster, Superintendent or District Official):

Name and Address of School or School System (include number, street, city, state, province, country, and postal code, phone and email
address):

Signature of Chief Administrator or Authorized Official (President, Headmaster, Superintendent or District Official):
Print Name:

Signature:

Title:

Date (mm-dd-yyyy):

This form is subject to release, on written request, to the applicant. (Privacy Act of 1974, Freedom of Information Act)
DS-7003
xx-xxxx

Page A8

About The Fulbright Teacher Exchange Program
(Please submit to authorizing administrator along with form)
The purpose of the Fulbright Teacher Exchange Program is to help promote mutual understanding between the people of the
United States and the people of other countries through educational exchange. International teachers and administrators
participating in the program have the opportunity to live and work abroad by exchanging or shadowing positions with educators from
similar institutions in the United States.
International Fulbright Exchange Teachers usually exchange positions with U.S. teachers for an academic year, semester, or
shorter period of time. By living and working in the cultures of their host country, the United States, international educators gain an
understanding and appreciation of the similarities and the differences between nations.

If your teacher is proposed for an

exchange, your school will have the opportunity to review the credentials of the U.S. teacher and to accept or reject the proposed
exchange arrangement. In order for an exchange to take place it must be approved by authorizing officials of the U.S. applicant's
school system, as well as the J. William Fulbright Foreign Scholarship Board (FSB). At the time of this application your
signature on the reverse administrative approval form simply enables your teacher to be eligible for the program and
indicates your willingness to consider a Fulbright Teacher Exchange at your school/university.

The success of the Fulbright Teacher Exchange Program in increasing international understanding and properly representing the
educational system and other aspects of your country's life and culture depends greatly upon the exercise of judgment by school
administrators in approving their teachers'/administrators' participation in the program. It is important to the reputation of the program
and your country's educational system, as well as that of the participating school, that an applicant be approved for participation only
if the approving official has no reservations about his or her character, reliability, and adaptability and judges him or her to have
superior qualifications and to be an excellent representative of your country's educational system.

Most exchanges occur with the teacher of your country and U.S. teacher receiving their regular salaries from their home schools
while teaching and living abroad, though specific arrangements vary for each country. Your school will not be asked to pay the
salaries of the U.S. exchange teacher. Housing arrangements are the responsibility of the teachers involved.

Both the international and U.S. teacher will be provided with a limited medical insurance policy by the U.S. government. However,
your teacher should continue his or her current coverage from your school, and we encourage you to consider including your
visiting teacher and any accompanying family members in your local group health plan.

Please return this form to:
The Fulbright Commission or Post in your home country.

DS-7003

Page A9

*OMB Approved No. 1405-0114
Expiration Date: xx/xx/xxxx
Estimated Burden: 2 Hours

IMMEDIATE SUPERVISOR REFERENCE FOR APPLICANT
IMPORTANT: The success of this program depends on the selection of educators whose qualifications give promise of outstanding
success under unusual circumstances abroad. Please see Fulbright Teacher Exchange Program description on the reverse of form.
ID#:09

1. Name of Applicant (last, first, middle):
2. Check the Applicant's professional qualifications and personal traits:
Item

Superior

Average

Above Average

Below Average

PROFESSIONAL QUALIFICATIONS
Knowledge of the subject field
Effectiveness with students of diverse levels of preparation
Ability to work with colleagues, including those with divergent views
Adherence to established administrative policies and procedures

PERSONAL TRAITS
Adaptability
Resourcefulness
Self-reliance
Initiative
3. Additional comments on the applicant's professional competence, experience, accomplishments, and personal qualities. Also indicate
any limitations. Use additional page if necessary.

4. Number of years you have known applicant:

5. Is the applicant a full-time teacher or administrator?

Yes

6. Please provide a general description of your teacher's school/university. Comment on how you feel the school, university, or district will
benefit from participating in the Fulbright Teacher Exchange Program. Use additional page if necessary.

7. Can your international teacher's course-load be altered for the U.S. teacher?

Yes

Please describe any special consideration that could be given to the incoming exchange teacher, (e.g., orientation, reduced teaching
load, extra preparation periods, special assignments teaching about U.S. culture, special support staff to assist exchange teacher with
instructional or related duties, other). Please continue on the reverse of this page, or use additional sheets.

Name and Job Title (include Dr., Mr., Mrs., Ms., Miss):

10. Name and Address of School (include number, street, city, state, province, country and postal code, phone and email address):

11.

Print Name:

Signature:

12. Title:

Date (mm-dd-yyyy):

This form is subject to release, on written request, to the applicant. (Privacy Act of 1974, Freedom of Information Act)
DS-7003
xx-xxxx

Page A10

Additional Space for Items 3, 6 and 8

About The Fulbright Teacher Exchange Program
(Please submit to authorizing official reference along with form)
The purpose of the Fulbright Teacher Exchange Program is to help promote mutual understanding between the people of the United
States and the people of other countries through educational exchange. International teachers and administrators participating in the
program have the opportunity to live and work in the United States by exchanging positions with educators from similar institutions.

International Fulbright Exchange Teachers usually exchange positions with U.S. teachers for an academic year, although semester
and shorter term programs also exist. By living and working in the culture of their host countries, they gain an understanding and
appreciation of the similarities and the differences between nations. Visiting teachers share new perceptions with their students, and
the returned Fulbright Exchange Teachers transmit an ongoing sense of awareness about what is happening in that part of the world
in which they have been living and teaching.

Please return this form to:
The Fulbright Commission or Post in your home country.

DS-7003

Page A11

REFERENCE FOR APPLICANT

*OMB Approved No. 1405-0114
Expiration Date: xx/xx/xxxx
Estimated Burden: 2 Hours

IMPORTANT: The success of this program depends on the selection of educators whose qualifications give promise of outstanding success
under unusual circumstances abroad. Please see Fulbright Teacher Exchange Program description on the reverse of form.
ID#:09

1. Name of Applicant (last, first, middle):
2. Check the Applicant's professional qualifications and personal traits:
Item

Superior

Above Average

Average

Below Average

4. Professional relationship to the applicant:

5. Number of years you have known the applicant:

6. Name and Job Title (include Dr., Mr., Mrs., Ms., Miss):

7. Professional Address (include institution, number, street, city, state, province, country and postal code, phone number and email
address):

9.
Print Name:

Title:

Signature:

Date (mm-dd-yyyy):

This form is subject to release, on written request, to the applicant. (Privacy Act of 1974, Freedom of Information Act)

DS-7003
xx-xxxx

Page A12

About The Fulbright Teacher Exchange Program
(Please submit to authorizing official reference along with form)

The purpose of the Fulbright Teacher Exchange Program is to help promote mutual understanding between the people of the
United States and the people of other countries through educational exchange. International Teachers and administrators
participating in the program have the opportunity to live and work in the United States by exchanging positions with educators from
similar institutions.

International Fulbright Exchange Teachers usually exchange positions with U.S. teachers for an academic year, although semester
and shorter term programs also exist.

By living and working in the culture of their host country, they gain an understanding and

appreciation of the similarities and the differences between nations. Visiting teachers share new perceptions with their students, and
the returned Fulbright exchange teachers transmit an ongoing sense of awareness about what is happening in that part of the world
in which they have been living and teaching.

Please return this form to:
The Fulbright Commission or Post in your country

DS-7003

Page A13

REFERENCE FOR APPLICANT

*OMB Approved No. 1405-0114
Expiration Date: xx/xx/xxxx
Estimated Burden: 2 Hours

1. Name of Applicant (last, first, middle):
2. Check the Applicant's professional qualifications and personal traits:
Item

Superior

Above Average

Average

Below Average

4. Professional relationship to the applicant:

5. Number of years you have known the applicant:

6. Name and Job Title (include Dr., Mr., Mrs., Ms., Miss):

7. Professional Address (include institution, number, street, city, state, province, country, and postal code, phone number and email
address):

9.
Print Name:

Title:

Signature:

Date (mm-dd-yyyy):

This form is subject to release, on written request, to the applicant. (Privacy Act of 1974, Freedom of Information Act)

DS-7003
xx-xxxx

Page A14

About The Fulbright Teacher Exchange Program
(Please submit to authorizing official reference along with form)

International Fulbright Exchange Teachers usually exchange positions with U.S. teachers for an academic year, although semester
and shorter term programs also exist. By living and working in the cultures of their host country, they gain an understanding and
appreciation of the similarities and the differences between nations. Visiting teachers share new perceptions with their students, and
the returned Fulbright exchange teachers transmit an ongoing sense of awareness about what is happening in that part of the world
in which they have been living and teaching.

Please return this form to:
The Fulbright Commission or Post in your home country

DS-7003

Page A15

File Type	application/pdf
File Title	DS7003.far
Author	manguerranc
File Modified	2008-09-25
File Created	2008-09-18