Carl Malmberg Fellowship 2016-17
Application
Please print or type. Use additional sheets if necessary. Completed applications must be received by March 31, 2016.
Name
Last/Family
Work
Address
Mailing Address
Work Phone
Home or
Permanent
Address
First
Middle
Maiden
Work Fax
Work E-mail
Home Fax
Home E-mail
Mailing Address
Home Phone
Other Personal Information
Date of Birth (Month/Day/Year)
Country of Citizenship
City/Country of Birth
Gender
Female
Marital Status
Male
Number of Children and their ages
Education
List institutions attended above secondary school level. Start with most recent.
Institution
Dates
Degrees Received
Dates
(Month/Year) or Expected
Received or
From …To
Expected
Fields of Study
Major
Minor
2016-17 Malmberg Announcement, p. 1 of 3
University of Pittsburgh
University Center for International Studies, Global Studies Program
Carl Malmberg Fellowship
4100 Wesley W. Posvar Hall, Pittsburgh, PA 15260 USA
Phone: 412 624-3487; Fax: 412 624-4672; E-mail:tfa3@pitt.edu; Web: www.ucis.pitt.edu/global/malmberg
Fellowships, Honors, Extracurricular Activities, Publications, Exhibitions, Performances, etc.
Occupational Experience over the past ten years
Name and address of Employer
Dates (Month/Year)
From …To
Position
Experience outside your country
Name each country, period of stay, purpose, e.g. study, vacation, armed forces, government, etc. It is essential that the applicant
specify exact period of time spent away from country. List most recent first.
Country
Period of Stay
Purpose
2016-17 Malmberg Announcement, p. 2 of 3
University of Pittsburgh
University Center for International Studies, Global Studies Program
Carl Malmberg Fellowship
4100 Wesley W. Posvar Hall, Pittsburgh, PA 15260 USA
Phone: 412 624-3487; Fax: 412 624-4672; E-mail:tfa3@pitt.edu; Web: www.ucis.pitt.edu/global/malmberg
Personal Statement
On a separate sheet of paper, prepare a narrative profile of yourself as an individual. It should deal with your personal history;
influences on your career and intellectual development; the educational cultural and other opportunities to which you have been
exposed; and the ways in which these experiences have affected you. Also include your special interests, abilities, career plans
and life goals. Please limit the profile to 500 words in English and submit it with your application.
Statement of Proposed Fellowship Activities
On a separate sheet of paper, please describe your plans for the use of the Fellowship and the goals it would help you achieve.
For instance, you might wish to identify types of courses you want to attend, internships you may want to experience, as well as
other professional and non-professional activities you seek while in the United States. Please relate how you would use the
Fellowship to advance your long-term career goals and how it would contribute to the improvement of your capabilities and the
development of your country. Please limit this statement to 500 words in English and submit it with your application.
English Language Report Form
The English Language Report form must be completed and signed by a professional English language teacher (preferably by a
college or university faculty member or an appropriate member of the United States Embassy) and submitted via Submittable.
References
Three original letters of reference, signed. These letters may be submitted via Submittable.
* A suggestion to those writing recommendations: The selection committee is especially interested in assessments of the
candidate’s abilities, achievements, promise for future achievement in his or her career, and the possible future contributions
the candidate might make to the well-being of the Lesotho.
List below the three persons from whom you have asked Letters of Reference.
Name
Title
Address
Phone
I hereby confirm that the information given on this application form is truthful, complete, and up-to-date. I understand that the
Carl Malmberg Fellowship is a non-degree fellowship, and that courses taken at the University of Pittsburgh or elsewhere as part
of the Fellowship will not earn credit towards an academic degree, either during the Fellowship or after its completion.
Signature of Applicant
Date
Completed applications must be received by March 31, 2016.
Late or incomplete applications will not be considered.
2016-17 Malmberg Announcement, p. 3 of 3
University of Pittsburgh
University Center for International Studies, Global Studies Program
Carl Malmberg Fellowship
4100 Wesley W. Posvar Hall, Pittsburgh, PA 15260 USA
Phone: 412 624-3487; Fax: 412 624-4672; E-mail:tfa3@pitt.edu; Web: www.ucis.pitt.edu/global/malmberg