Hubert H. Humphrey
Fellowship Program
Individual Program
PLAN
Date Submitted:
Fellow’s Name:
University:
Country:
University of California, Davis
Professional Statement
Explain in less than 500 words what you hope to being doing in your professional life in the next
five years.
Professional Goals:
List up to five professional goals for your Humphrey Fellowship year:
1.
2.
3.
4.
5.
Personal Goals:
List up to five personal goals you have for your Humphrey Fellowship year:
1.
2.
3.
4.
5.
Anticipated program activities to achieve your professional goals:
1. List courses, seminars, special campus lectures, affiliations, and networking with
professionals in the U.S. in which you would like to participate this year:
2. List skills you would like to acquire and experiences that you feel will enable you to practice
new skills and gain greater insight about leadership in general. Envision yourself five and ten
years from now in leadership positions as you compile this list:
3. List special workshops and seminars, including on and off campus, conferences locally or
out of state, IIE Enhancement Workshops (see the IIE website), etc.:
4.
List possible community and volunteer activities you will participate in during your
Humphrey Fellowship year :
5.
List potential topics or activities you would like to pursue with your American peers during
your Fellowship year and beyond.
Possible Contacts or Organizations (with the information you have gathered and listed above
and the research you have completed, please list below in the table provided the possible
organizations and individuals you might want to contact. Seeking an “informational interview”
after doing a good job researching what the organization and individual does, is often a great
way to network and learn more in your field. These initial contacts may even serve as links to
establishing a Professional Affiliation):
Name
Position
IPP
REVIEWED AND
DISCUSSED
DATE:
__________
COORDINATOR’S
INITIALS
COMMENTS:
Organization
Website
FELLOW’S
INITIALS
Contact information (may
be email, phone, address)
Hubert H. Humphrey
Fellowship Program
Individual Program
REPORT ON ACTIVITIES
Date Submitted:
Fellow’s Name:
University:
Country:
University of California, Davis
How have your goals changed since submitting your Individual Program PLAN (IPP)?
I. REPORT ON ACADEMIC PROGRAM ACTIVITIES
COURSES COMPLETED (Indicate all classes you have taken, include whether you audited or took
these classes for course credit):
Did you serve as a resource in any of your classes?
Explain:
UC DAVIS CAMPUS WORKSHOPS, SEMINARS & CONFERENCES ATTENDED (Indicate all
workshops, seminars, and conferences you have attended that were on campus. Be sure to
note what information or insights you gained from these events):
II. REPORT ON PROFESSIONAL DEVELOPMENT ACTIVITIES
HUMPHREY SEMINARS (List the topics of the seminars you attended and provide details on
the knowledge or insights you gained from these sessions):
OFF-CAMPUS PROFESSIONAL WORKSHOPS/CONFERENCES/SITE VISITS/FIELD TRIPS
(indicate topic, location, date and any knowledge or insights you gained from attending these
events):
LIST PRESENTATIONS YOU HAVE MADE (indicate topic, location, and date):
LIST SPECIAL PROFESSIONAL DEVELOPMENT PROJECT(S) OR ACTIVITIES (on or off campus) IN
WHICH YOU HAVE PARTICIPATED:
(For End-of-Year Report) IIE/HUMPHREY ENHANCEMENT WORKSHOPS (Indicate which IIE
Humphrey Enhancement Workshop(s) you attended. Note what you gained from this
experience. If you did not attend an enhancement workshop indicate that with “N/A” –
meaning not applicable):
III. PROFESSIONAL AFFILIATION (PA)
For Mid-Year Report (note the efforts you have taken to define your PA objectives, research
you have completed on possible organizations to affiliate with, contacts you have made, etc.):
For End-of-Year Report (note the organization you have completed your affiliation with,
activities and responsibilities that you have had during your affiliation, and what you gained
from this experience):
IV. COMMUNITY SERVICE
LIST ALL COMMUNITY SERVICE ACTIVITIES YOU WERE INVOLVED IN (i.e., these can be with
your church, a community organization, UC Davis HHH staff-organized, or other):
V. SOCIAL/CULTURAL ACTIVITIES
PARTICIPATION OR ATTENDANCE OF SOCIAL AND CULTURAL EVENTS AND ACTIVITIES (e.g.
Professional organizations, sports, church, Rotary Club, potlucks, community events, etc.):
FRIENDSHIP HOST FAMILIES (please comment on the kinds of activities you have done with
your host family as well as the relationship you have established with them):
VI. CONTACTS DATABASE
Include key contacts you have made, communicated with or met personally, during your
Humphrey year. This database will help you when you return by having a list of those you
added to your professional network.
Name
Title
Organization
Phone
Number
Email
Topic Area/
website
VII. PROFESSIONAL DEVELOPMENT EXPENDITURES
For Mid-Year Report - You are required to provide a general expense accounting of how you
have used your professional development funds at Mid-Year (December). Please complete the
Excel spreadsheet table below for Mid-Year reporting. It is okay if you have not used up your
funds by Mid-Year!
For Year-End Report - You will update your professional development budget report for your
final Year-End Report. Note: all professional development funds must be spent and reported by
program completion.
Professional Development Funds
Item
Description (if needed)
sample - Workshop #1
registration fee
sample - Workshop #1 hotel
sample - subtotal
Workshop #1
Sustainable Agriculture 2013 conf. in $
Sacramento, CA (April 4, 2013)
one night @ Holiday Inn
$
TOTAL PROFESSIONAL DEVELOPMENT EXPENSES
Expense
Totals
400.25
235.00
$
635.25
$
635.25
ANY ADDITIONAL COMMENTS (you may wish to write additional comments on
other aspects of your Humphrey year):
MID-YEAR
REPORT ON
ACTIVITIES
REVIEWED AND
DISCUSSED
DATE:
__________
COMMENTS:
COORDINATOR’S
INITIALS
FELLOW’S
INITIALS
Hubert H. Humphrey
Fellowship Program
For End-of Year Report
BEYOND THE FELLOWSHIP YEAR
This section is to be completed in your Final Report.
1. Continuing Your Professional Development Back Home (list ways you anticipate continuing
your professional development once you return home):
2. Implementing Change Back Home (identify ways you will use what you have learned during
your Fellowship Year in your home country):
3. Mentoring (consider how you might serve as a mentor to others in your home country):
4. Being a Humphrey Fellow Alumni (list ways you might stay connected to the Humphrey
Program and contribute to a strong alumni community):
END-OF-YEAR
REVIEWED AND
DISCUSSED
DATE:
__________
COMMENTS:
COORDINATOR’S
INITIALS
FELLOW’S
INITIALS