Form DS-7004 Teacher Exchange Program Hosting Application

HOSTING APPLICATION INSTRUCTIONS
Fulbright Teacher Exchange Program
Note: This application may be copied. Please use additional pages, if necessary to elaborate on any part of the application.
The hosting application is to be submitted by U.S. individuals
and/or schools/districts that are interested in hosting a
Fulbright teacher or administrator during a specific inbound
short-term program or to host an international Fulbright
teacher for a one-way year/semester length exchange.
If you are applying to host an international teacher or
administrator for a specific inbound short-term program,
please read the description of that program on the OTHER
OPPORTUNITIES page of our website carefully before
completing the application (http://www.fulbrightexchanges.org/
View/ViewOtherOpps.asp). Be sure that you meet eligibility
requirements for the program.
The application forms may be photocopied for interested
colleagues, and applications may be submitted on photocopied forms. However, applications must bear original
signatures.

Special Instructions

NAME OF PROGRAM FOR WHICH YOU ARE
APPLYING TO HOST
List the specific short-term program for which you are
applying to host. Include country, length of time and dates if
available, or write "all."
If you are applying to host any international Fulbright
Teacher, please list your countries of interest and whether
you prefer to host for a year, semester, or short program (3-5
weeks).

HOST PERSONAL INFORMATION
"Email Address(es)": Please list all addresses where you
can be contacted in order of priority.
"Description of Current Position": Information on the current
position of the host is critical to finding suitable matches.
This section should be filled out thoughtfully and completely.

"Foreign Language Fluency" and "Foreign Language
Assistance": Please list languages that might be relevant to
Hosting applicants should complete the entire application to
the hosting experience you would like to have and any other
the fullest extent. Depending on the hosting program for which
fluency of your staff.
you are applying, there may be some questions that may not
directly reflect your situation. Please adapt those questions
HOST SCHOOL INFORMATION
to fit your own experience. Please use additional sheets, as
"School Description": Information on the school/district of
necessary, to elaborate on any section of the application.
hosting applicants is critical to finding suitable matches. This
section should be filled out thoughtfully and completely.
Deadlines
Hosting applications are accepted on a rolling basis and
kept on file and considered for all programs. If you wish
to be considered as a host for a specific short-term
program, you application must be received before the
published deadline.

Mailing Address
Applications, related documentation, and all future
communication should be sent by post to:
Fulbright Teacher Exchange
HOSTING PROGRAMS
600 Maryland Avenue, SW, Suite 320
Washington, DC 20024-2520

U.S. hosts must provide a mentor for the international
teacher. The mentor's job is to assist the incoming teacher
or administrator in the host school system. If the mentor is
different from the host, please list the mentor's full contact
information here.
Please list the principal and superintendent names and
contact information. For year and semester exchanges, the
school system must accept placed candidates through an
official letter of acceptance from the Superintendent's office
and completion of a proposed assignments form (PAF) by
the principal. These forms will be provided by Fullbright at
the time the placement is proposed.

HOST INFORMATION
In some cases we may give preference to schools/districts
that can host more than one educator. Please accurately
assess the number of international educators you can host at
one time.
For year- and semester-long exchange hosting applicants,
please describe the type of assignment you will provide for
the incoming international teacher, as well as support and
monitoring that you will offer the teacher.
Short-term hosts should describe the experiences and
activities that you will provide. Please feel free to attach a
sample daily schedule for the exchange duration.

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HOUSING INFORMATION
Hosting applicants must provide or assist the
international educator in finding accommodation.
Applicants to host a year or semester one-way exchange
should fully describe inexpensive housing options that
might be available to the international teacher.
Short-term hosts should fully describe any home-stay or
hotel accommodation that will be provided. Home-stay is
preferred, except in the case of the Brazil principal
program.
Miscellaneous
Applicants should inform the Fulbright Teacher Exchange
Program in writing of:
a change of address or phone number;
a.
a change of plans affecting the application;
b.
a desire to withdraw the application;
c.
a termination of teaching contract;
d.
a change in assignment or school administration.
e.

PAPERWORK REDUCTION ACT: Public reporting burden for this collection of information is estimated to average one and a half
(1.5) 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.

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*OMB Approved No. 1405-0114
Expiration Date: xx/xx/xxxx
Estimated Burden: 1.5 Hours

U.S. Department of State

FULBRIGHT TEACHER EXCHANGE PROGRAM HOSTING APPLICATION
NAME OF PROGRAM FOR WHICH YOU APPLYING TO HOST
(List country, length of time and dates if available) (If applying in general, please list countries of interest)

HOST PERSONAL INFORMATION
Ms.
Title:
Mr.
Dr.

Mrs.

First

Last

Middle Initial

Miss

Home Phone

Home Mailing Address

Cell Phone
Email Address(es)

(Please list all address where you can be reached
in order of priority)

Position Title

In Present Position From (Date (mm-dd-yyyy))

Description of Current Position (Subject, Level, Duties)

Foreign Language Fluency (Iist those languages relevant to hosting program(s) to which you are applying and any others
and check the level of fluency for each language)
1.

Excellent

Good

Fair

None

2.

Excellent

Good

Fair

None

3.

Excellent

Good

Fair

None

Foreign Language Assistance (If you are not fluent in a language(s) relevant to the hosting program to which you are
applying we would like to know if there are other speakers of the language(s) in your school or community. Please check the
box below and list the language if you have other speakers that are available to assist.)
There are other

speakers in my school/community available to assist with communication

Explain why your school or school system would like to host a Fulbright grantee for a year, semester or
short-term program. Please explain how your school or school system would make use of the opportunity
to host an international educator (a) during the exchange, and (b) after the exchange. Feel free to write
this essay on a separate page.

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HOST SCHOOL INFORMATION
School Name, Address, Phone, Fax, and Website

Name of official Mentor for grantee
(If different from host)

Title of official Mentor (if different from host)

Mentor's phone and e-mail
(if different from host)

School Principal/Dean Name

School Principal/Dean Job Title

School Principal Phone Number and Email Address

Dates of School Year Terms (mm-dd-yyyy):
) Spring (

to

Fall (from

)

to:

Year-round

Number of Teaching Staff

Number of Students in School

School Type

School Location
Public

Private

Religious

Urban

Suburban

Yes

No

Rural

School Description

(include academic level, composition of student body, teaching methods, resources, special features or program).

School District Name and Address

Superintendent's Name

School District Phone

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HOSTING INFORMATION
Number of Educators You Can Host Preferences
Teacher

Administrator

Other

Male

Female

Either

(For some programs we may give preference to schools/districts that can host more than one educator.)

Describe any previous hosting experience

Describe how you and your school/school district will benefit from hosting

Describe how you and your school district will support the incoming international teacher through mentoring and
other activities. Describe the teaching assignment you can offer the incoming international teacher (especially
important for year long or semester hosting applicants). Use additional pages, if necessary.

Describe the types of other experiences you will be able to provide the incoming international teacher
(classroom observation - 1 day is required - observation of PTA meetings, school board meetings, local volunteerism, etc.)

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HOUSING INFORMATION
For year/semester programs, please explain what inexpensive housing options the school will be able to provide
or assist with - housing for the grantee should be near the school or near public transportation routes. Grantees
will be able to pay their own rent.

For either a semester/year or short term program, a home-stay is to be provided:
I will provide home-stay: attach brief description of accommodations
Someone else will provide a home-stay: attach sheet with name, address and phone of home-stay host(s) and a brief
description of accommodations.
(Please include number and type of pets, smoking or non-smoking accommodations, etc.)

For short-term programs, hotel accommodation will be provided:
We will be able to organize a reasonably-priced (government rates or lower) hotel for the group near out school.
(Participants will carry funds for hotel rates).
Please provide the name of the person in your district who will be responsible for making these hotel arrangements, the
name of the prospective hotel, and the cost per room (double occupancy):

For Year and Semester Exchanges
The school system must accept placed candidates through an official letter of acceptance from the
Superintendent's office and completion of proposed assignment form (PAF), and mentoring form provided by
Fulbright at the time the placement is proposed.
Mail / Fax Completed Applications to:
Hosting Program
FULBRIGHT TEACHER EXCHANGE PROGRAM
600 MARYLAND AVE SW SUITE 320
WASHINGTON, DC 20024
FAX: 202-479-6806
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