President Fellowship Program Coversheet
1.
Presidential Fellowship Nominee Information
Name:
E-mail Address:
Department/School:
Enrollment Term:
Student ID:
Phone Number:
Degree Program:
Anticipated Graduation Term:
(ex. Fall 2016)
(ex. Spring 2021)
2. Previous Institutions, Degrees, and GPAs
Institution
3.
Degree Awarded
Year Awarded
Final GPA
GRE Scores (Quantitative Reasoning/Verbal Reasoning/Analytical Writing)
a. GRE General Test Score :
/
/
b. GRE Subject Test:
c. GRE Subject Test Score:
/
/
4. Date of Interview:
5. Interview Mode: ☐ In-Person
☐ Skype
☐ Other
d. If this was an in-person interview, was a Recruitment Travel Request submitted prior to the travel?
☐ Yes ☐ No
6. Proposal/Project Title (if known):
7. Source of GA Support:
8. Amount of GA Support: $
(9 month appointment)
9. Faculty Mentor Information
Faculty Mentor Name:
Department/School:
Phone Number:
Title:
Email Address:
1
Revised: klsr, 12/8/15
@nau.edu
10. Nominator Information (if different from Faculty Mentor Information)
Nominator Name:
Department/School:
Phone Number:
Title:
Email Address:
@nau.edu
11. Recommenders
Recommender 1 Name:
Email Address:
Title:
Phone Number:
Recommender 2 Name:
Email Address:
Title:
Phone Number:
Recommender 3 Name:
Email Address:
Title:
Phone Number:
12. Outside Fellowships for which Student Is Currently Applying
Fellowship Name
Fellowship Amount and Frequency (ex. $5,000/yr)
13. Other External Funds that Do/Will Support the Student
Fund Name
Fund Amount and Frequency
2
Revised: klsr, 12/8/15