Internship Offices Network
McGill University
Leacock Building, Room 307
855 Sherbrooke Street West
Montreal, Quebec, Canada
H3A 2T7
PFF Community Leadership Program – Fellowship Application Form
Please read the instructions very carefully. Late or incomplete applications will not be accepted.
Please TYPE your answers.
Personal Information
Name:
(Last name)
(First name)
McGill Student ID Number: ________________________________________________________________
Faculty and Year: _________________________________________________________________________
Program(s): _______________________________________________________________________________
Expected Graduation Date: __________________________________________________________________
Date of Birth: _____________________________________________________________________________
Country of Citizenship: ______________________________________________________________________
Mailing Address and Contact Information
Street Address:_________________________________________________________________________________________________________________________
City/Prov./Country:
Telephone #:
Postal Code:________________________
McGill Email Address: ____________________________________________________@mail.mcgill.ca
Permanent Address (if different from mailing address)
Street:________________________________________________________________________________________________________________________________
City/Prov./Country:
Postal Code:________________________
Telephone #: ____________________________________________
Projects do not require affiliation with a sponsoring organization, but endorsement from a local organization or community leader is
essential.
Project Name:___________________________________________________________________________________________________________________________
Project Location: ________________________________________________________________________________________________________________________
Project Duration and Dates: _______________________________________________________________________________________________________________
Project Summary (2 sentences maximum):___________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Endorsing Partner’s Name (organization, business, group or individual): ________________________________________________________________________
Page 1 of 8
Short Bio (150 words maximum)
Detailed Project Proposal
1.
Project Description
Please provide a detailed description of your project. What are the community needs you are addressing, as well as the needs and
requirements of your community partner? What are your objectives and expected short and long-term results? How will the project
bring positive social change to the community in which you plan to work? Why have you chosen this project? Describe how your
project is innovative and/or entrepreneurial, if applicable. (1000 words maximum)
Page 2 of 8
(Question 1 continued)
2.
Please provide a detailed timeline for your project. The timeline should outline each stage (and activities) of your project and should
specify the dates by which you intend to achieve your goals. It should also specify how you will ensure the project remains on
schedule. (500 words maximum)
Page 3 of 8
3.
Sustainability
Is your project sustainable? How will the positive impact on the community successfully continue following your departure? Can
the project expand once you leave? (250 words maximum)
4.
Project Environment
Describe the socio-economic, cultural and/or political environment of the community, region or country in which your project
would be implemented. Provide a description of the potential impact your project will have on the community (e.g., on public
health, the environment, social issues, gender-related issues, etc.). Describe how you will ensure the project does not have a
negative impact on the community. (500 words maximum)
Page 4 of 8
5.
Please describe your local community partner. What is the partner’s role in the community and why did you select them? Do you
have prior links to or experience dealing with your partner? Is your partner capable of providing you with support and guidance
during your project? In what other ways can your partner contribute to your project? (250 words maximum)
6.
Risks and Challenges
Describe all potential risks and challenges in implementing your project. These could include operational or financial risks, risk to a
sponsoring organization’s reputation, etc. Outline your strategy for averting or mitigating such risks. (250 words maximum)
Page 5 of 8
7.
The Applicant
Outline any experience you have that is relevant to the proposed project, as well as any volunteer activities you have engaged in
previously. (250 words maximum)
8.
Describe any courses/training/workshops you have taken or will take in advance of the project that will help you to succeed in
project implementation. Be sure to clearly indicate which courses/training/workshops you will only take if you obtain this
fellowship (250 words maximum).
Page 6 of 8
9.
Please describe your qualifications to implement your project in your community of choice. Please evaluate your ability to integrate
into the community based on existing links to it, as well as previous experience living, working or travelling overseas. Please
indicate your languages capacities with regards to the community of your choice (250 words maximum)
10. References
Please provide us with the names, titles, phone numbers and e-mail addresses of the individuals providing you with your reference
letters, as well as the name, title, phone number, e-mail address and, if applicable, address of your sponsoring organization or local
community partner.
Page 7 of 8
Application Checklist
Cover page with name and title and abstract of the project (max. 100 words)
Application Form
Budget form
Letter of interest (max. 1 page)
Applicant CV
Official McGill transcript in sealed envelop
Two letters of recommendation sent directly by e-mail to Anne Turner anne.turner@mcgill.ca
Letter of Support from a person of influence in the community or a decision maker of the local community partner
Expert evaluation form
I have read the PFF Community Leadership Program handbook and understand what my obligations will be prior to the start of the
project, during the project and following completion of the project.
I understand and consent that my entire application (form and appendices) will be shared with the selection committee for the purposes
of evaluation.
I understand and consent that, if selected, I will be required to submit monthly reports to the Internship Offices Network, and that my
reports may be shared with the Pathy Family Foundation.
I understand and consent that Fellowship recipients will be invited to promote the Program at the University when feasible (e.g.,
presenting their experience at information events) and that materials submitted by recipients may be used on the Fellowship website.
Fellowship recipients will be asked to share contact information and possibly communicate with the Pathy Family Foundation post
selection.
For projects outside of Canada
I understand that I must attend a University-wide pre-departure session (April 2014).
http://www.mcgill.ca/internships/events/
I will register my travel on the University travel registry.
http://www.mcgill.ca/students/international/registry/
I have read and will adhere to the University-Related International Travel Guidelines listed at:
http://www.mcgill.ca/files/secretariat/International-Mobility-Guidelines.pdf
DECLARATION
I hereby declare that the information contained in this application is accurate and true.
Signature:
__________________ Date:
PLEASE SUBMIT APPLICATIONS ELECTRONICALLY TO:
ANNE TURNER AT ANNE.TURNER@MCGILL.CA
BY 12:00 PM (EST) February 3, 2014– No late or incomplete applications will be accepted.
All applicants will be notified of the final decision for their application.
Page 8 of 8
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