The Frederick Douglass Teaching Scholars Fellowship
Application for Appointment
Priority Consideration Given to Completed Applications Postmarked by January 16, 2016
Name:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
Home
Phone: (
State
Cell
Phone: (
)
Work
Phone:
)
ZIP Code
(
)
Email:
Do you have active status in a terminal degree program?
YES
NO
If yes, please complete the following:
Program:
(PhD)
University:
(Department)
City
State
Expected date of degree completion (Month / Year):
Please indicate your current situation (Check all that apply)
Have earned MA (provide year degree was conferred)
Taking course work in a doctoral/terminal program
Have completed required course work in a doctoral/terminal program, but have not passed oral exam
Have passed oral exams and working on dissertation
Have earned my PhD (provide year degree was conferred)
Other (please explain)
Name of your major/program:
Adviser:
Major adviser’s mailing address:
Major adviser’s phone number:
(
)
Do your future plans include teaching in higher education?
Yes
No
Do you have college or university teaching experience?
Yes
No
As a teaching scholar, what undergraduate course(s) are you most interested in and/or best prepared to teach?
Most Interested
Are you willing to be considered for (check all that apply):
Best Prepared
Summer Position
Full-Year Appointment
Signature of Applicant:
How did you learn about this fellowship?
Advertisement (Source):
Posting (Where posted):
Other (Please Specify):
NOTE: This application must be accompanied by:
*A cover letter describing your research area(s), experience and qualifications
*A curriculum vita
*A copy of your graduate transcript(s). (At the application phase this can be a copy of the official transcript)
*A letter from your major or dissertation adviser regarding your qualifications for this program.
*A letter from at least two additional references regarding your experience and ability. (If you have teaching experience,
letters should include relevant information.)
Send this application and related materials to the universities of your choice. You are permitted to apply to more than one
university, but you must send separate application materials to each school.
***PLEASE NOTE: APPLICANTS TO FDI SCHOLARS FELLOWSHIP MAY UNDERGO A CRIMINAL BACKGROUND CHECK AS
PART OT THE SELECTION/HIRING PROCESS AT EACH UNIVERSITY.***