Brandeis University Women’s
Studies Research Center
Scholars Program
Dissertation Scholar Application
Instructions
Thank you for your interest in the Scholars Program at the Women’s Studies Research Center
at Brandeis University. All of the information and materials necessary to apply are contained in
this packet. Applicants are asked to submit application materials in one complete package to
the following address:
Scholars Program Admissions
Women’s Studies Research Center
Brandeis University, MS 079
415 South Street
Waltham, MA 02454
We look forward to receiving your application!
ADMISSIONS REQUIREMENT
This affiliation is designed specifically for those people that are in the midst of working on their
dissertation at an accredited institution. In order to be considered for admittance to the
Scholars Program, your dissertation must have a focus on women and/or gender issues.
APPLICATION MATERIALS
Please submit 7 copies of each of the following:
Completed and typed original application form (with original signature) and 6 copies.
7 copies of your current Curriculum Vitae
7 copies of a 2-3 page description of your proposed project. Tell us how you think
this program will assist your work, and how your work will contribute to the Scholars
Program. Please be as specific as you can in describing your project, methods, goals,
experience and the value of your work.
1 representative work sample (Guideline for work sample: 7 copies of articles or
chapters; 1 copy of slide sheets, books, DVDs, VHS, CDs, etc.).
You may send more than one work sample. If you would like your work sample(s)
returned, be sure to read the “please note” section for further instructions.
3 letters of recommendation (only typed letters will be accepted)
The application form, CV, project proposal, work sample and letters of recommendation
must be submitted by June 1, 2011. Incomplete applications will not be considered.
Decisions regarding your application will be mailed on or about July 15, 2011.
You must sign and date the application.
ADMISSIONS DEADLINE
The Scholars Program at the Women’s Studies Research Center at Brandeis University offers
enrollment commencing every fall (September 1).
Applications must be received, in their entirety, by June 1, 2011, no later than 4:00 p.m.
Please send your application in one package.
Incomplete applications cannot be reviewed by the Admissions Committee.
LETTERS OF RECOMMENDATION
Letters of recommendation must be typed and included with your application packet. The
letter must be sealed and the evaluator must sign her/his name over the seal of the envelope.
Please do not have evaluators send their letters directly to the Center as we cannot guarantee
that they will make it into your admission application.
PLEASE NOTE
Applications will not be returned by the Admissions Committee.
Representative work samples will be returned on August 1 if requested and accompanied by a
self addressed stamped envelope.
INQUIRIES
Inquiries regarding the application process or status of your application should be directed to
Rosa Di Virgilio Taormina, Scholars Program Director, via phone at: 781-736-8111, or via
email at: taormina@brandeis.edu. Please understand that we cannot give specific advice on
how to best complete the application so as to guarantee acceptance.
DISCRIMINATION POLICY
Brandeis University does not discriminate on the basis of race, color, sex, sexual
orientation, religion, national origin, age, genetic information, disability, or status as a
veteran in its programs and activities. The following person has been designated to
handle inquiries regarding the nondiscrimination policies:
Special Assistant to the President for Equal Opportunity
Stoneman 143
781-736-3015
*The Dissertation Scholar position is a one-year maximum affiliation.
Brandeis University Women’s
Studies Research Center
Scholars Program
P
Dissertation Scholar Application
2011-2012
E R S O N A L
D
A T A
Legal name:
Last
First
Female
Male
Middle Initial
Preferred name, if not first name (choose only one):
Former last name(s) if any:
Birth date:
E-mail address:
mm/dd/yyyy
Permanent home address:
Number and Street
Apartment #
City or Town
State/Province
Permanent home phone
ZIP/Postal Code
Country
Cell phone
If different from above, please give your mailing address for all admissions
correspondence.
Number and Street
Apartment #
City or Town
State/Province
Phone at mailing address:
Citizenship:
United States
United States Permanent Resident
Other:
ZIP/Postal Code
Country
O P T I O N AL I N F O R M AT I O N
The information provided here will not be used in a discriminatory manner.
Place of birth
City State/Province Country
Language(s) other than English in which you are fluent:
US Armed Services veteran?
Marital status:
Yes
Never married
No
Separated
Married
Divorced
Widowed
If you wish to be identified with a particular ethnic group, please check all that apply:
African American, African, Black
Native American, Alaska Native
Asian American
Hispanic, Latino
Mexican American, Chicano
Native Hawaiian, Pacific Islander
Puerto Rican
White or Caucasian
Other:
O
T H E R
R
E Q U I R E D
I
N F O R M A T I O N
Have you ever been convicted of a misdemeanor, felony or other crime? If yes, on a separate
sheet of paper, please give approximate dates of each incident and explain the circumstances.
E
D U C A T I O N A L
I
N F O R M A T I O N
List all universities attended beginning with undergraduate, include degree earned and year
achieved.
Name
City/State or Country
Degree Earned
Year
Name
City/State or Country
Degree Earned
Year
Name
City/State or Country
Degree Earned
Year
Name
City/State or Country
Degree Earned
Year
Name
City/State or Country
Degree Earned
Year
P
R O J E C T
I
N F O R M A T I O N
Title of Dissertation:
Primary Field of Dissertation:
Brief Summary of Dissertation (not to exceed 5 lines):
S
H O R T
A
N S W E R
Q
U E S T I O N S
Please answer the following questions. Responses should be brief and should not exceed a half page
in length.
1. Do you anticipate being able to finish writing your dissertation during the year you are affiliated with
our Center?
2. How does your work fit in with our mission?
3. What do you hope to gain from an affiliation with the WSRC?
R
E F E R E N C E S
Please list the names of your references, their title, how long you have known them, and in what
capacity you know them.
Name:
Length of Time Known (in years):
Title:
Name:
Length of Time Known (in years):
Title:
Name:
Length of Time Known (in years):
Title:
Capacity Known:
Capacity Known:
Capacity Known:
O
T H E R
How did you learn about the Scholars Program at Brandeis University:
Current Scholar:
Website
Scholar Alumna:
Mailing (calendar, postcard, etc.)
Friend
E-mail Event Notification
Center Director or Staff Member
Other:
S
I G N A T U R E
/ V
E R I F I C A T I O N
I hereby certify that all information submitted in the admission process, including the
application, supplements, any supporting materials – is my own work, factually true, and
honestly presented.
______________________________
Signature
____________________
Date