Application for Blakemore Freeman Fellowship for Advanced Asian Language Study or Blakemore Refresher Grant

Name Primary Email Address Alternate Email Address Telephone Mailing Address Your Citi enship Status I am a U.S. citizen I am an Alien with U.S. Permanent Resident Stat s!Alien Registration No. !f awarded a Blakemore Freeman Fellowship or Blakemore Refresher Grant" ! plan to use the grant for language study at the following language program in #ast or Southeast Asia$ "ang age "ang age Program %See instr ctions $or list o$ appro&ed programs' #ate that yo r application was or will (e s (mitted to lang age program listed a(o&e) %It is the applicant*s personal responsi(ility to apply to the lang age program (y its p (lished deadline.' %rincipal Academic or %rofessional &onors #ates o$ st dy Birthdate

%revious study of the language for which ! am applying$ +ighest "e&el ,ompleted %e-ample) .th /ear ,hinese' %0or Bla1emore 0reeman 0ellowship applications only2 please attach list o$ all college3le&el lang age classes ta1en $or this lang age2 incl ding co rse names2 dates and locations o$ st dy.' St dy a(road or other programs attended Colleges or 'niversities Attended Please provide us with official transcripts from all institutions at which you have studied for more than one year. Official electronic transcripts or documents in original unopened sealed envelopes from the issuing institution are both acceptable. Instit tion Ma4or #egree 5 #ate %recei&ed or e-pected'

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Recommendation Letters Please enclose recommendation letters in sealed unopened envelopes with your application or have recommenders send letters directly to the Foundation by mail, fax (20 !"#$!$%%&' or email to bla(emorefoundation)gmail.com. Name o$ Recommender 67 Title!Position Uni&ersity or 8rganization Address ,ity!State!9ip ,ode Email Telephone Name o$ Recommender 6: Title!Position Uni&ersity or 8rganization Address ,ity!State!9ip ,ode Email Telephone Application Agreement I ha&e read the 0o ndation;s Eligi(ility Re< irements2 Selection ,riteria and =rant = idelines as p (lished on the Bla1emore 0o ndation;s we(site at http)!!www.(la1emore$o ndation.org. I (elie&e that I < ali$y $or a Bla1emore 0reeman 0ellowship or Bla1emore Re$resher =rant (ased on this in$ormation. I con$irm that I am not related to any o$ the c rrent mem(ers o$ the Bla1emore 0o ndation Board o$ Managers as o$ the date o$ this application. I a thorize the lang age program listed a(o&e to release in$ormation on my admittance stat s and res lts o$ any written or oral tests cond cted as part o$ the program*s application process directly to the 0o ndation. #ate Signat re Application (eadline$ %ostmarked )y (ecem)er *+" ,-+,

Send all materials to new mailing address$ Bla1emore 0o ndation Attn) E gene +. "ee2 Tr stee 7:>7 Third A&en e2 S ite .?>> Seattle2 @ashington ?A7>7 www.(la1emore$o ndation.org Phone) %:>B' CD?3AEEA 0a-) %:>B' CD?3?EEA (la1emore$o ndationFgmail.com or (la1emoreFper1inscoie.com =rant st dy m st start (etween G ne :>7C and May :>7.. No de$errals will (e permitted. All grants are awarded contingent pon the applicant*s nconditional acceptance (y the lang age program. HUnconditional acceptanceI means that the applicant m st not (e re< ired to complete a s mmer program as a prere< isite to academic year admission to the lang age program.

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A%%L!CA.!/0 !0S.R'C.!/0S
Send all materials to new mailing address$ Bla1emore 0o ndation Attn) E gene +. "ee2 Tr stee 7:>7 Third A&en e2 S ite .?>> Seattle2 @ashington ?A7>7 www.(la1emore$o ndation.org Phone) %:>B' CD?3AEEA 0a-) %:>B' CD?3?EEA (la1emore$o ndationFgmail.com or (la1emoreFper1inscoie.com #ligi)le Languages ,hinese B rmese Gapanese Jorean Thai Kietnamese Indonesian Jhmer

Approved Language %rograms o o o o o The Bla1emore 0o ndation awards grants $or st dy only at speci$ic lang age programs as noted (elow. 8nly one lang age program may (e listed on the application. Applicants $or Bla1emore lang age grants m st sim ltaneo sly apply to the lang age program in&ol&ed and to the Bla1emore 0o ndation. Each lang age program has its own separate application d e date and $orms2 which may (e $o nd on the speci$ic program*s we(site. 0or Gapanese2 we $ nd st dy at the Inter3Uni&ersity Program $or Gapanese "ang age St dies in /o1ohama2 Gapan %http)!!www.stan$ord.ed !dept!IU,!'. @e do not $ nd Gapanese lang age st dy at any other instit tion. 0or ,hinese2 we $ nd st dy at the Inter3Uni&ersity Program $or ,hinese "ang age St dies2 located on the Tsingh a Uni&ersity camp s in Bei4ing2 ,hina %http)!!ieas.(er1eley.ed !i p!' and at the International ,hinese "ang age Program at National Taiwan Uni&ersity in Taipei2 Taiwan %http)!!iclp.nt .ed .tw!'. @e do not $ nd ,hinese lang age st dy at any other instit tion. 0or Jorean2 we recommend st dy at Seo l National Uni&ersity %http)!!lei.sn .ac.1r!site!en!1lec!main!main.4sp'2 /onsei Uni&ersity %http)!!www.ys1li.com!inde-.asp' or Sogang Uni&ersity %http)!!1lec.sogang.ac.1r!'. @e will consider st dy at other Jorean lang age programs on a case3(y3case (asis d ring the application re&iew process. Appro&al o$ lang age programs $or st dy o$ lang ages o$ SE Asia will (e considered on an indi&id al (asis d ring the application re&iew process.

1aterials to Be Su)mitted for Blakemore Freeman Fellowship Application

,ompleted and signed application $orm. Itemized list o$ all college3le&el lang age classes ta1en (y applicant $or the Asian lang age listed on grant application2 incl ding co rse names2 dates and locations o$ st dy. Essay %three to $o r pages in length2 do (le3spaced' disc ssing) o Applicant;s academic2 pro$essional or ( siness (ac1gro nd o Prior st dy and se o$ the lang age and in&ol&ement with the Asian co ntry o ,areer o(4ecti&es and how the lang age will (e sed to achie&e them Two recent letters o$ recommendation $rom indi&id als $amiliar with applicant;s academic2 pro$essional or ( siness e-perience. 8$$icial college and ni&ersity transcripts $rom all instit tions at which applicant has st died $or more than one year. Electronic transcripts or o$$icial paper doc ments are (oth accepta(le. I$ applicant has not completed C academic years o$ st dy o$ the lang age at the college le&el2 s (mit the 0oreign "ang age Re$erence 0orm2 completed (y a lang age instr ctor or other similar < ali$ied indi&id al a(le to e&al ate the applicant*s lang age competency. 8therwise2 do not s (mit the $orm. Applicants $or programs in&ol&ing t torials sho ld s (mit the $ollowing additional in$ormation with their application) o #escription o$ the proposed t torial program o In$ormation regarding the proposed t tors; pro$essional < ali$ications

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o o

Estimated costs $or t toring e-penses The applicant;s proposed a$$iliation d ring the grant period with a recognized ed cational instit tion in the Asian co ntry.

1aterials to Be Su)mitted for Blakemore Refresher Grant Application 2former Blakemore Freeman Fellows 3 see separate instructions )elow4

,ompleted application $orm Essay %three to $o r pages in length2 do (le3spaced' disc ssing) o Applicant;s academic2 pro$essional or ( siness (ac1gro nd o Prior st dy and c rrent se o$ the lang age and in&ol&ement with the Asian co ntry o ,areer o(4ecti&es and how the lang age is (eing sed to achie&e them 8ne recent letter o$ recommendation $rom indi&id al $amiliar with applicant;s academic2 pro$essional or ( siness e-perience. , rric l m &itae "atest o$$icial college transcript %applica(le only to those who ha&e not recei&ed a doctorate'. 8$$icial electronic transcripts or doc ment in original nopened sealed en&elope $rom the iss ing instit tion are (oth accepta(le. Applicants $or programs in&ol&ing t torials sho ld s (mit the $ollowing additional in$ormation with their application) o #escription o$ the proposed t torial program o In$ormation regarding the proposed t tors; pro$essional < ali$ications o B dget $or estimated t toring e-penses o The applicant;s proposed a$$iliation d ring the grant period with a recognized ed cational instit tion in the Asian co ntry

1aterials to Be Su)mitted )y former Blakemore Freeman Fellows for Blakemore Refresher Grant

,ompleted application $orm Essay %two to three pages in length2 do (le3spaced' disc ssing) o Reasons $or re< esting additional lang age st dy o Use o$ the lang age since last recei&ing a Bla1emore grant. , rric l m &itae Applicants $or programs in&ol&ing t torials sho ld s (mit the $ollowing additional in$ormation with their application) o Applicant;s proposed a$$iliation d ring the grant period with a recognized ed cational instit tion in the Asian co ntry

Application .imeline

#ecem(er C7 L Postmar1 deadline $or applications Gan ary L Application receipt ac1nowledged (y email 0e(r ary 3 Applications re&iewed (y 0o ndation March 3 0inalists noti$ied (y email and inter&iews cond cted "ate March!early April 3 =rantees selected and noti$ied o$ grants "ate April L Names o$ grantees posted on we(site

Additional !nformation Concerning Application 1aterials "etters o$ Recommendation o No special $orms are sed. A letter printed on a recommender;s pro$essional letterhead is pre$erred. o "etters o$ recommendation disc ssing applicant;s o&erall a(ilities2 to the e-tent 1nown (y the recommender2 are pre$erred to those which are limited to e&al ating an applicant;s lang age s1ills. o "etters o$ recommendation may (e incl ded with application in sealed nopened en&elopes or may (e sent directly to the 0o ndation (y the recommenders (y mail2 $a- or email. o Recommendations sent nder separate co&er sho ld (e addressed to) Bla1emore 0o ndation2 7:>7 Third A&en e2 S ite .?>>2 Seattle2 @ashington ?A7>7. "etters sent directly (y the recommenders may

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also (e $a-ed to %:>B' CD?3?EEA or emailed to (la1emore$o ndationFgmail.com. 0oreign "ang age Re$erence 0orm This $orm is s (mitted 8N"/ i$ the applicant has not completed C years o$ st dy o$ the lang age at the college le&el. It sho ld (e completed (y a lang age instr ctor or other indi&id al competent to assess applicant*s lang age a(ilities. Transcripts o 8$$icial transcripts may either (e incl ded with application or sent nder separate co&er. 8$$icial electronic transcripts or doc ments in original nopened sealed en&elopes $rom the iss ing instit tion are (oth accepta(le. o Photocopies o$ transcripts $rom instit tions located o tside the United States will (e accepted i$ o$$icial transcripts are not readily o(taina(le. o Transcripts are re< ired only $rom ni&ersities at which the applicant has st died $or more than one year. , rric l m Kitae or Res me o @e recommend a c rric l m &itae or res me (e incl ded with an application $or a Bla1emore 0reeman 0ellowship2 ( t it is not re< ired. A c rric l m &itae or res me is re< ired $or an application $or a Bla1emore Re$resher =rant.

1ailing !nstructions

Application materials sho ld (e care$ lly addressed2 sing the complete mailing address o$ the 0o ndation. In pre&io s years materials ha&e (een delayed or e&en ret rned to the sender (y the U.S. Postal Ser&ice d e to a missing s ite n m(er or incorrect zip code. Please note that o r mailing address has changed. Application materials sho ld (e addressed to) The Bla1emore 0o ndation E gene +. "ee2 Tr stee 7:>7 Third A&en e2 S ite .?>> Seattle2 @ashington ?A7>7

Application (eadline

Applications m st (e postmar1ed (y #ecem(er C7. An application recei&ed a$ter #ecem(er C7 m st show proo$ o$ mailing (y the deadline consisting o$ one o$ the $ollowing) o A legi(ly dated U.S. Postal Ser&ice postmar1M o A legi(le mail receipt with the date o$ mailing stamped (y the U.S. Postal Ser&iceM o A dated shipping la(el2 in&oice or receipt $rom a commercial carrier %0ederal E-press2 United Parcel Ser&ice2 etc.' o @e recommend that applications sent $rom o&erseas (e shipped well (e$ore #ecem(er C7 or (e sent (y e-press deli&ery in order to ens re that the application is recei&ed in a timely manner.

For further information" please contact$ ,athy Schei(ner2 Assistant to the Tr stee Bla1emore 0o ndation 7:>7 Third A&en e2 S ite .?>> Seattle2 @ashington ?A7>7 Telephone) %:>B' CD?3AEEA Email) (la1emore$o ndationFgmail.com or (la1emoreFper1inscoie.com

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FOREIGN LANGUAGE REFERENCE FORM

Name of Individual Applicant

Language

INSTRUCTIONS: Please check the applicants present language ability in relation to each of the following categories: SPEAKING AN LISTENING !Plea"e c#ec$ one%

o o o o o o

Unable to f n!t"on "n t#e $%o&en lan' a'e Able to $at"$f( ba$"! $o!"al nee)$ an) *a"nta"n +e,( $"*%le !on+e,$at"on "n fa*"l"a, to%"!$ Able to $at"$f( ,o t"ne $o!"al )e*an)$ an) l"*"te) -o,& ,e. ",e*ent$ Able to %a,t"!"%ate effe!t"+el( "n *o$t fo,*al an) "nfo,*al !on+e,$at"on$ on %,a!t"!al an) $o!"al to%"!$ an) on %,ofe$$"onal to%"!$ "n ,e$t,"!te) !onte/t$ Able to $e t#e lan' a'e fl entl( an) a!! ,atel( on all le+el$ %e,t"nent to %,ofe$$"onal nee)$ U$e of lan' a'e "$ f n!t"onall( e. "+alent to a -ell-e) !ate) nat"+e $%ea&e,

REA ING !Plea"e c#ec$ one%

o o o o o o

No %,a!t"!al ab"l"t( to ,ea) t#e lan' a'e 0 ff"!"ent !o*%,e#en$"on to ,ea) +e,( $"*%le !onne!te) -,"tten *ate,"al "n a fo,* e. "+alent to $ al %,"nt"n' o, t(%e$!,"%t 0 ff"!"ent !o*%,e#en$"on to ,ea) $"*%le1 a t#ent"! te/t$ on $ b2e!t$ -"t#"n a fa*"l"a, !onte/t Able to ,ea) -"t#"n a no,*al ,an'e of $%ee) an) -"t# al*o$t !o*%lete !o*%,e#en$"on a +a,"et( of a t#ent"! %,o$e *ate,"al on nfa*"l"a, $ b2e!t$1 a$ -ell a$ te!#n"!al *ate,"al Able to ,ea) fl entl( an) a!! ,atel( all $t(le$ an) fo,*$ of t#e lan' a'e %e,t"nent to %,ofe$$"onal nee)$1 "n!l )"n' all *ate,"al$ "n one3$ $%e!"al f"el) Rea)"n' %,of"!"en!( "$ f n!t"onall( e. "+alent to a -ell-e) !ate) nat"+e $%ea&e,

Plea"e indicate &'iefl( #o) t#e evaluation )a" dete'mined !e*g*+ , (ea'" of cou'"e)o'$+ a te"t+ etc*% -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Na*e of E+al ato, E+al ato,3$ In$t"t t"on

0"'nat ,e 4e%a,t*ent

4ate 5o$"t"on o, 6"tle

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