2016 CARLSON CIVIC FELLOWSHIP
Student Application
Instructions
Please send completed
applications, in both Word and
.pdf formats, to engage@uw.edu
by 5:00 pm on Monday,
October 19, 2015. Applications
received after the deadline will
not be accepted.
Questions?
Contact Talya Gillman in the
Carlson Center, at 206-5434282, engage@uw.edu -- or visit
MGH 171!
I. Personal Information
Name:
Student Number:
Preferred Phone Number:
Preferred Email Address:
Your Studies
Major(s):
Minor(s):
Expected Quarter and Year of Graduation:
II. Fellowship Interests
Please closely review position descriptions at: http://www.washington.edu/carlson/public-servicefellowships-and-awards/carlson-civic-fellowship-students/.
Which of the three community partner organizations are you interested in working with as a
Carlson Civic Fellow? (You can apply for multiple positions, if you are interested in each of the
projects.)
Asian Counseling and Referral Service’s Civic Engagement Fellow (Engaging the API Community)
Puentes’ Community Mobilization Fellow (Ending Migrant Detention)
Solid Ground’s Advisory Council Fellow (Racial and Economic Justice)
III. Short Answer Questions
Please thoughtfully respond to each of the questions in the boxes below, limiting your
responses to 250 words or less.
1. Please explain why you are interested in working with the community organization(s) you
indicated above. (If you are applying for multiple positions, please provide a separate, specific
answer for each organization.)
2. Why are you interested in being a Carlson Civic Fellow? How will each of the specific
components of this program (i.e. participating in a leadership courses, reflection and coaching,
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etc.), the experience working with a community organization over an extended period of time, and
the $2,500 stipend deepen your ability to serve and practice leadership in the community?
3. We are looking for students who have shown dedication to activities of importance in their lives –
and who will demonstrate a similar commitment to Fellowship activities. Please describe a school,
community, work, family, or extracurricular responsibility to which you have been most committed in
your life. Specify the length/frequency of commitment and your role(s) or position(s). Note any
significant accomplishments you have achieved and/or challenges you have navigated while
participating in this activity. What are you proud of? What have you learned about yourself through
the experience?
4. What social problem do you think is the most urgent crisis in your community and/or in today's
society at large? Why is this issue important to you?
5. Describe an experience working with someone different from you. What made it easy? Difficult?
What did you learn from the situation about how to interact with others in respectful, productive
ways?
6. Are you currently receiving financial aid (i.e. grants, work-study, loans)? (Note that this is for
informational purposes only; federal financial aid status is not a deciding factor in the Carlson Civic
Fellowship application process.)
Yes (if yes, please provide details below)
No
IV. Fellowship Commitments
If selected as a Carlson Civic
Fellow …
Please review the Fellowship requirements below, and
indicate whether can commit to these activities.
I will commit a minimum of 10 hours per week to Fellowship-related service with my
community organization from January through June 2016.
Yes
I will commit to monthly check-in meetings with Carlson Center staff, to meaningfully
reflect on my experiences and to assess progress toward my Carlson Civic Fellowship
goals.
Yes
I will commit to taking a three-credit Community-Based Leadership course (“General
Studies 348: Critical Perspectives on Service and Community Engagement”) during
Winter Quarter.
Yes
No
No
No
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I will commit to participating in a Martin Luther King, Jr. Day of Service project on
Monday, January 18, 2016.
Yes
I will commit to preparing and presenting a poster presentation at the Spring
Celebration of Service and Leadership on Wednesday, May 11, 2016.
Yes
I will commit to participating in an end-of-year Fellows Celebration in late May 2016 to
the best of my ability (date TBD).
Yes
No
No
No
V. References
Please provide contact information for two individuals (excluding family members) who are
familiar with your community involvement and/or family responsibilities. Include their name,
specifically how you know the person, their phone number and email address (if available).
Reference 1 Name:
How you know this person:
Phone:
Email:
Reference 2 Name:
How you know this person:
Phone:
Email:
IV. Interview Process
The Carlson Civic Fellowship Interview process has two components. Students with exceptional
applications will be invited to a first round interview with Carlson Center and other UW staff. A
select group of students will then be invited for a second round interview with representatives
from the community organization at which they are applying to serve as a Fellow.
1. FIRST ROUND interviews will be scheduled on Monday, November 2 and Tuesday,
November 3 between the hours of 12:00-6:00 pm. Please note any times within these two
time frames that you are unavailable for an interview.
2. SECOND ROUND interviews will take place on Friday, November 6 between the hours of
5:00-8:00 pm. Please note any times within this time frames that you are unavailable for an
interview.
Applicants who engage in a Second Round Interview will be notified of final decisions by Tuesday,
November 10.
Thank you for your application!
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