University Application

Family Name *

Middle Name

Given Name *

Gender *

Male

Female

Faculty Rank/Title *

Address *

City *

Province *

Institutional Email Address *

Personal Email Address *

Phone *

Alternate Phone

Institution *

Names of Nominating Director and Dean at your Institution *

Passport Number *

Passport Expiration Date *

Year

Month

Day

Date of Birth *

Year

Month

Day

Place of Birth *

Upload Passport Copy *

Please upload a copy of the face page of your passport.
More information

Files must be less than 2 MB.
Allowed file types: gif jpg png.

Have you participated in a J-1 visa program in the United States in the past 24 months? *

Yes

If you selected "Yes" above, please upload a copy of your previous DS-2019

More information

Files must be less than 2 MB.
Allowed file types: gif jpg png.

Date of your current teaching appointment *

Year

Month

Day

List of courses you teach and research projects *

List all Academic Awards

Statement of Purpose *

Please explain why you wish to participate in the HEEAP Program and how you will leverage the program to advance the goals and objectives of HEEAP in your instruction and across the curriculum at your University. Responses are not to exceed 400 words and must be written in English.

Upload your resume *

Please attach your resume/vita and a published/academic paper (not to exceed 10 pages) These documents must be submitted in English. Please attach the documents in one file with this form. File formats that are allowed for submission are Adobe Acrobat PDF (.pdf), Microsoft Word (.doc), rich text format (.rtf) or plain text(.txt). Your resume and writing sample need to be contained in the same document. Only the following types of files are allowed to be uploaded: Adobe Acrobat PDF (.pdf), Microsoft Word (.doc), rich text format (.rtf) or plain text(.txt)
More information

Files must be less than 9.77 MB.
Allowed file types: txt rtf pdf doc.

Please indicate your highest degree achieved *

Ph.D

Master

Bachelor

Please indicate the academic discipline of your Ph.D

Please indicate the academic discipline of your Master Degree

Please indicate the academic discipline of your Bachelor Degree

What is the level of your English writing? *

What level can you comprehend English? *

What level are you fluent in speaking English?

Did your rector and dean approve your nomination into the HEEAP Program? *

Yes

Choose One...

Please indicate which discipline you are a faculty member of *

If you selected other to the previous question please indicate what your discipline is

Agree *

I agree

By selecting 'I agree', I am applying for participation in the Higher Engineering Education Alliance Program. I understand that the completion and submission of this form does not guarantee placement in the program. I have examined this form and confirm all of the information is true and correct to the best of my knowledge.

Search form