Please respond to the following questions by selecting one of the boxes.

Summer 2020 term application deadline: April 1, 2020

Name (As listed on passport)
	Given Name		(Middle Name)	Family Name
Country, City, Institution
Are you a citizen of your country of residence?	☐ Yes ☐ No	Will you be living in your country during the AE E-Teacher course?		☐ Yes ☐ No
Email Address (Please use your own email address.)
Phone Number [country code][area code] [local number]
	For example, [1][555][1234567]
Term	☐Summer 2020 (July 7, 2020 Start date; Orientation available June 1 - 26, 2020)

Statement of Purpose: Please explain your reasons for wanting to participate in the courses you selected. What impact will your participation in this program have on your institution, or region, and how do you expect to use the knowledge acquired in this course?

How will you share the information you will learn with your colleagues after the completion of the course? (Check as many boxes as apply)

☐ Other ________________ ________________ ________________

☐ Conferences

☐ Distributing material

☐ Presentation

☐ Workshops

Please assess your present English language proficiency. (select one)
Understanding of written English	☐ Excellent ☐ Good ☐ Fair
Expressing yourself in written English	☐ Excellent ☐ Good ☐ Fair

Please respond to the following questions by selecting one of the boxes.


I have taken an online course before	☐ Yes ☐ No
I have regular and reliable access to high-speed internet connection.	☐ Yes ☐ No
I commit to spending 10 to 12 hours online each week for the duration of the 8-week course to participate in this course.	☐ Yes ☐ No

Please assess your computer skill level. (select one)

☐ Excellent ☐ Good ☐ Fair