![A) What technica] subjects, tcplcs, courses-and/or fields do vou want t study? (lt Is important tc glve a
detalled description of the training you want. USDA wtll use this inf irmatlon te design vour training
prograrn in the United 'States. Continue on back of page).
1
-.-·~'·.·'"·_ __""""'··.""'''·V'~ tr $è' .•••tJ6' 1·m'-8~;b"'~~~'~~"·- ._•••••••••••• ......., ••••••'"_.,..o/~~'''~~~_.;~·~-,~c"._. '--._-"••••··'Y",""··,""··'; ••••·-'''''6""''''''•••·-'·.•'''''_~·••••••,•••' "'""""""'_-...""""''''''''' •••••• _'''''''''.....,_ ••••• -r- ,-..,- --- --- ._- _.- - ·rt.'8HY~···rwr; ~'srhC'i 1·"-' ,·&--ftAiict .•••
,
1
f
1
1..1.$.Contacts Jlready Established: Plèêlse lIst narne, address, and tt-fephone nurnber of profsssioMIS ln your
fi ero ln ~he United St?t,,~, w!th whcrn velu alreadv hl>W# contact. 1
N~me NaJa
i
III, PROPOSED PROGRAM:
E)
'Title Title
Company Cornpanv
Addrass Address
Telephone Telephone
Company
Address
Telephone
From Tc
C) Training dates: Please li.stany dates YOl) are NOT avallable for the program
From Tc
From Ta
Page 2 oflO](https://image.slidesharecdn.com/cochranfellowshipprogram2018-171209094038/85/Cochran-fellowshipprogram2018-5-320.jpg)
Cochran fellowshipprogram2018
- 1. - j'ai le plaisir de vous informer que le Département. Améri '.ln de rAgriculture (US DA) a . retenu pour le Programme de Stages Cochran pour l' année ~018 les thêrqes suivants : ;jii"'!'!,;:, ";';Chhi:f~€~il~l!;iRiiIl~ii~><ie'''''I.ùr~blé (Market ReJ! . within th. Wheat Vaine USDA United States Departrnent of Agriculture Foreign Agricultural Service Monsieur le Directeur de la Coopération Internatiolple Ministère du Commerce Objet: Programme de Stages Ceehran pour l'année 201 ~ Office of Agrieultural Affairs American Embassy Tunis, Tunisia Tunis, le 8 novembre 2017 2/ Introduction aux s;t~u:adaid~,'iu~nitnir~sdes aliments (Introduction IQ Food Safety Reglliations) --~- -. 1 3iLogîslîq~ !los grain •• ":..gestion Iks ~ (Gl'ain ~g(sfC' and Silo Management) LéS;Càtlâidats.pottmtic!sdésignés par vos services devront l' anplir le formulaire Cochran, ci-joint, et le l'envoyer au Bureau des Affaires Agricoles à l' Ambassade des Etats .•Unis d' Amérique à Tunis, au plus tard le 15 décembre 2017, Les interviews de sélection auront Heu ultérieurement. Je tiens à vous informer que l'trSDA prend à sa charge tous It":sftàls'irihérents au stage (inscription, logement. repas, isitcs, assurance médicale et transport àl'Intérieur des Etats-Unis) alors que le transport! les frais de visa et le timbre de voyage sont à la charge de la partie 'Iunlsienne, Dans l'attente de vous voir, je vous prie, Monsiêur le Direct nir, de croire à l'assurance de ma considération, Morgan Haas Attaché Agricol e Ambassade dès Et""",-~. Tunis~Tunisie
- 2. " The Embassy's point of contact for the Coc 'an Fellowship Program is the Office orAgricultural Affairs, which can be r eached by e-mail at: AgTunÎs@fas.usda,gov. The Embassy of the United States of America avails itself ofthis oPP~rt~i.tY't~~ênë;"totfie'îvf.'fnlstry"ürFôiëign Af :âù-:stlfé A âssiirâi1ëêTOf"itsF "-" ---- highest consideration. , '. -2- As stated. Embassy of the United States of America, Tunis, ie9 ~ll.v.ZD11:
- 3. ••.--l~. No. 1638 ,. [) • ~:: •• J -, "~o. _",","<on. ' 'Ct ' ••••• "'*'.'""Th~"En1biSsyo1t11ëtJiütea..StàfëSÔf~i'i~ arpresents'its"?" - '" "'",,"'..-mA 0' 1 ..- '0- •••• compliments to the Ministry of Foreign Affairs of'jhe Republic of Tunisia and has the honor to request the Ministry' s assistan ce i11 transmitting the attached letters and application fonn for the 2018 Œochran Fellowship - Program to the following recipients: i .' 1 1 ~~-J !i 1 IodNOO le "" ..,.'--'.--"...•.. .~~::9~T~!.§.M-_~-..~ ~Lia;ro';;;iI)i'l"!~L1 . ! i '.-,,"v _ Ministrv of Agrictllture~ Water Resource and Fisheries; 1 1 1 The letters announce the 2018 Cochran FeU iwship Program and encourage candidates to apply, This program pr? ides D.S. based agrioultural training opp01'tunities for senior and niid-level specialists, rese archers, and administrators from the public an iprivate sector, who are involved in agricultural trade, agribusiness develo ment, management, poli-cy, or marketing. The Embassy requests the retum of 111e cornpleted 2018 Cochran Fellowship Program application forms to the Offi .e of Agricultural Affairs prio-r to December 1592017.
- 4. . MN FELLOWSI-/IP PROGRAM 2018 APPLICATION FORM NOTE: PlËASE TYPE) .D ATTACHMENTS MUST BE I~ ENGLISH ***"''''**** COMPLETE o APPLICATION SHOULO INCLUO!::!: c 2L etters of Recommendation n 2F 'hotoqraphs 1" 'i>' '- db r '$'" rrt,.; -Ô"""""P11 :lfôêôpÎ'êsôfP'âsspbrfS" . , Mt"C' h"- . , . (fr nt page only) CJ SiCIned Conditions of Training Q M, dical Clearance Documentation (uiDon acceptance into the proqram) o SUned PI10to Consent Form 1 MALE . 0l"MA" 0 US'DA~ ; COCH " ',~ _'Z ';:;. ;, ~'V" :p '" _ ': JJ~ 1.PERSONAL INFORMATION Name: -- _ Famlly Name Given Name 2 "ftiairŒ rrllîsfëôr~ 'i)('âêtiVWtnpS'sp'ôl't~6tt'ralè' documents) Date of Birth: (Day 1Month 1Vear) e-s- 03/March/1970 City of Birth: __ ~ _ Country of Blrth: ~ ~_ Countrv of Cltizenship: _~ _ Have vou ever ap-p!ied for U.S. Citizenship: Ve~ No Home Andrass: # Str!!)et ._~-~~-------~ (Home Tel;elihone) Town or City (PersonallV obl!e TelephOtie) Country and [lost Code 11.CURRENT EIVI?i.OYMENT: (Personal E nàil Address) Title or Position Fr.om: Dates of Err plovrnent . lJrganlzàtlohjCompany IfStreet Work Telep rene FaxTown or City Work Mobl e TelephoneCountry and Post Code Work Emal Address Page 1 of Iû
- 5. A) What technica] subjects, tcplcs, courses-and/or fields do vou want t study? (lt Is important tc glve a detalled description of the training you want. USDA wtll use this inf irmatlon te design vour training prograrn in the United 'States. Continue on back of page). 1 -.-·~'·.·'"·_ __""""'··.""'''·V'~ tr $è' .•••tJ6' 1·m'-8~;b"'~~~'~~"·- ._•••••••••••• ......., ••••••'"_.,..o/~~'''~~~_.;~·~-,~c"._. '--._-"••••··'Y",""··,""··'; ••••·-'''''6""''''''•••·-'·.•'''''_~·••••••,•••' "'""""""'_-...""""''''''''' •••••• _'''''''''.....,_ ••••• -r- ,-..,- --- --- ._- _.- - ·rt.'8HY~···rwr; ~'srhC'i 1·"-' ,·&--ftAiict .••• , 1 f 1 1..1.$.Contacts Jlready Established: Plèêlse lIst narne, address, and tt-fephone nurnber of profsssioMIS ln your fi ero ln ~he United St?t,,~, w!th whcrn velu alreadv hl>W# contact. 1 N~me NaJa i III, PROPOSED PROGRAM: E) 'Title Title Company Cornpanv Addrass Address Telephone Telephone Company Address Telephone From Tc C) Training dates: Please li.stany dates YOl) are NOT avallable for the program From Tc From Ta Page 2 oflO
- 6. ,0, , IV, EMPLOYMENT: (Start wlth current employment) A) bates of Employment (CURl'tENT EMPLOYMENT) Tc: Present'From: Organlzation Name " Number & Street Title of Position: Town or City Supsrvls r's Name Supervls ir's Telephone Org-aniz' tien Telephone Description of vour place of ernplovrnent and your duties llnd responsibliltles: (Continue on tl~e back of the page if necessarv). 1'1)Dates ofEmplovment , . .~ From: To: Orgar!Îzation Nerne ---,--'---, -Number &. Street Titi", of Position: Town or City Country and Post Code 1Suparvlsor's Name 1S,'''''',''';,, Te'eph"" Organiz atlon Telephone Description of veur place of employment and your dutles and respenstbüitles: Page ê of 10
- 7. Al What do Vou want the appllcant to learn while in the United States for trai 1ing? V. TRAINING BENEFiTS: How will vour employer USEvour training wheD you return from the United Sta .es? VI. SUPERVISOR'S RECOMMENDATION FO~ APPLlCAI'IlT'S TRAINING: 1 . '1H~ wi" th, "'"''"''' 'ro'ni", be ussd oy 'he 0,,""'''''0" when h_/,h_ r'u,ns from th. Uni,edState51 1 Det@ Thank Vou. Signature Jîtle Page 40fHJ
- 8. VII. ACADEMie EDUCATION AND TRAINING EXPERIENCE A) Academie B) Training: (List additional training în home country). )0.- e_ C)Aclditional Training in Other Ccuntries: 1___ ~_. ,__l__.~_~_.~ --l.._~, __ ~+_--:- -LI_~ ~ AWàrds,. Hcnèrs, Schol;;lfShips Raeelved, Publicatlans; Professionat Memb lfShips: VIII. LANGUAGES (Please indicate ENGUSH capablflties in flrst line, additlonal languages on rarnalnlng llnes}. Only requlres Interpretation for complsx discussions IJttle to none Understands bu~ r~qulres InterpretationEnglish Speaking Reading Writing Other Languages Page 5 of 10 Does not raqulre te rpratatlon
- 9. Relatlor'lshl(:l: ~_----- (Mobile Telephc le) ~- HO" ·"'·WH1-'tM "Mrri'tiÙft~-.,.. IX. NAME AND ADDRESS OF PERSON TO CONTACT lN CASE OF EMERGENCV: (Home Telephon ~) (Name) (Email Address) . (# Street) (City orTown) (Country and Post Code) PleaseInclude with vour application the follcwlng attachments: 1.) 2 passport photngraphs 2.} 21etters of recommendatlon S.j Signee! Conditions of Trafning 1 1 i1 .Page 6 of10
- 10. COCHRAN FELLOWSHIP PROGRAM CQNDITIONS OF TMININ,f2 Name of Fellaw ~_----~-~-~--~----I(FAMILY NAME; Giv(;m name, Other Mmes) Country _~ --~ If 1 am accepted to recelve teehnical training under the U.S. Depart ent of Agriculture (USDA) Cochran Fe!owshlp Program, 1 agree to adhere ta my arranged prcgrem, to devote my tlme and attentlon to rny studles and/or practlcal training, and to conform to C chran Program regulatlon s and prccedures for' the duratlon of my training prograrn. Upan my eturn, 1 agree to provide feedbOick ta training provlders and FASstaff as requested. 1will not see . extension of the period of my pro gram but will return to my country without delay upon complet on .of my training acquired ......_ _-=-- -# ••••under·thisllrogram:-"'l.also-agree.to.confarm~to..aJl.l.a.Jil/.s..Q.t"".tJ..!.h".e..:z:!.!:.!.;n~jt,;:e~Q':;:'~:J:lta~f~s:'.;..:•••.•••••••••••••••••••.•''6••••,••••••.'''''.-· ••••••~_·e •••e•••·__ Furthermore, 1thoroughly understand the fOllowing requirements and p~Iicles of the Cochran Fellowship prograrn: L Dep!;nden~ USDAdoes not permit famlly mernbers to accompany or je n aFellow while he/she is in training. Ii. Atte-pdal~ce of ré(loW5 at Confl~rencesand Meetlng;;;l Att~ndançe o'r fellews at natlcnal or international c }nferences, conventions or meetings of prOïassionaL trace, or ether .associatlons ldnot psrmltted unlass such attendance is [3 p:~fi:of the cochran Fetlowship training pr· gram. USDAresetvesrhe right to tarmlnate the training program of those F01l1oWS who; A. Change the course of study Of depart th01 prcgram w thout aurhorlzanon frcrn the USDAjCodm:irî Fellowship Program. ' e. Fail tc show suffldent interest in or to pursue effecti tely their training prograrn. C, Have severe mental of physical haalth problerns. D. Conduct themsalves ln a mariner prejudicial to the irograrn or to the laws of the United states. E. Marry ouring training without secunng prier USDAa preval. F. Have ln any way falslfied Information on the a )plicatl.on and/or supporting documents. G. Not ccmpllent with Two Year Residencè Requiremer t for DS2019 SEVISProgram. If selectad, the appltcant, thelr lnstltution, or ether sponsor a surnes ftnanclal respcnslbilitv for air travel to and fram WOlshington, D,C. or their specifled arri al/d@parture site. FellaW5 are not perrnltted to rent or drive vehic/es during thelr Cochran Fellows Ip Program. Page 7 of Iû ..
- 11. The applicant is aware that the financlal support provided by :he USDA Cochran Progr~m is for training fees, ernergencv medical lnsurance. dornestlc transport itlon, lodging 'and food Pll.!Y.. The ctaily maintenance allowance ls based on U.S. sovernment S"rvice Adminlstrates rates and is adequate for modest lcdging and food. U$DA does not fund My xpenses related to famlly rnembers acccmpanvlng the Fellow. V. FioancialSugoort: The Cochran Fellowship program does NOT cover the cost of Inte national atrfare, Please initiai nere to lndicate you understand this requtrernent. _ Do you have guaranteed/approved funding from your company o organlaatlon? Yes"",:" No_ VI. .!:l.~8Ithand !nsuri"Jnce; •••",,,,,..•.••"'...••._.•.••~-"""'"~_·.·'"'_·••·"•.•••.•.•••••••""""'_·"'l'!t~is~fequiremel1t-b~fore<.ar:r.îval...in...thE!.lJnited~States.J:hat~e.LeQ ...Bl.l1Çl_'<lL.hg~.g.";!liy~l""c""al"".e",x;:::a"",m,,,,,.i""nQ"'"~t.••lz.on•.•.••.•••.•••..•.•.•••.•__•••.'•••••_,_' ••.'•••••. and be determined to be in good health, Proof of madlcal fitn .55 (a ~igned latter 'From a medical doctor withln 1 month of the prcgrarn start date) is raquired bei re you will be allowed to travel to the United States as a Cochran F~f1ow, The insurance provldec to the Feltow while ln the United States will cover ~ EMEnGENCY medlcal cere and OOES 1 OT cover pre-exlstlng condltlons, prescriptions, dental or cptlcal work. ln addition, the Fellow nav be responsible for paving the establlshed deductible ($100,00) for each occurrence, 1 unde rstand th~t USOA and its training providers are not respenslble for any eosts related to medical ca 't;! while ln the United States. VII. Qebts and Obl1.g11tions: The FeUow will be responslble for ail debts and fi'1.mcial oblig: ,tions mcurred while in the United Stlites. p, ~ ••••• _" •. ~ 'tNh@ri'you@gree te p,lM:ielpatè ln' ME>ù:hange Visitor Prograrhanct yOUT program fuUs under the é!mditk:ins· expfaÎMcJ bei'ov,yoU, ·wil! bè.· sUbJèct te 'the tWQ,Vq,j':i'·nomè+eoulitry phV5ica!pfe$2nl:~ {-ror:E!g;'re,sîdli!nce.)I'~qujrgment~ ,-i,/s m~ans vou wll! Ci;! requirs' ;to rr;Jtumtoyour home country for 'twoyèats at the end of ydurexc;hM~é visitor program. ihls re.(ùirl1!rr'len1: under immigration law is based on S.p.t;:tion212{e) of the lmmlgratlen and NoationêlityAct. -fwo"year Homl!!·Country Physki.!!Presence ~eqlJlrement COl'ldit ons - An exchange v!sitor ls subject to the two-vear home country phvska: presence requlrernent if the following conditions exlst: Government funded excl1ange program - The program 11"1 which tlle exchange visltor WOlSparticipatlng was flnanced in whcle or in part directly or indlrectlv by the U,S, government or the gcvernrnent of 'the axchange vlsltor's natlcnallty or last residence, .{. htt Signature be-Iow indicates a-greement to and understandlng of the above cond 'ions, Appllcant's Slgn;;lttJre )ate. Page 80f10
- 12. PHOTO CONSENTIRELEASE l hereby consent ta the royalty-free use by the United States Depart lent of Agriculture (USDA) ofphotographfs) taken of me by employees/representatives of the U;nA Office of Communications, Photography Services Division, und of any reprcd .iction of the photographes) in any form, in an)' media, for any purpose in connection with USD .,world-wide. free and clear of any clairn whatsoever on my part. 1 also consent to the use with the photographes) of my narne and an comments 1may have made . at the time of the photographes), including the editing thereof, Furthermore, I understand that this consent includes consent to USI A ta use the photographes), . with or without my name and any commente, for educational, prom tional, and outreach _____ ~p.•..urposes, and to use alone or in conjunction with ether types of mal erial, including use on the '"'iirtêTriët anaôthêî("'fu~an'il-of1'ubHc·display. _............ OOc 'Wb' -' .------------------ I hereby release the United States, its officers, and employees from liability for any violation of any right I may have in connection with the foregoing use. I hereby waive any right of inspection or approval of the photogra h(s) or of the use that may be made of the photographes), my name, and my commentes). l am of legal age, Signature _~ 1Date Name ----~---------------------- Telephone N( , -~-------~ (Plesse Prmt) Address ______--__----------------------------.l~------------- Page 9,of 10
- 13. First 2018 Cochran [ellowshtp Program Applicant Bio Last C.y Place of Residence: ----~-l~------ Country Education Tltl€~ ~ ~_I.~----- Engllsh Langu<i€e skills Name: __~ _ .Companv/Organizatlon: _~ __ II-- ~ _ Description of ernplcver and appllcant dut es and respcnsibtltttes:û a-'. '~~ _ _ __~,," . ._ .. ' F'--~--17r - *# a' &èr-x English Speaking Reading Writing Spedflc technlcal subjacts, topics, ccursedand/or fields the appltcant ls lnterested ln: Under tands but re [ulres lnterpr rtatlcn Little tc nene Only requlres Interpretation for ccmplex dlscusstcns Does not require tnterpretaticn Page10000