ANNE RILEY FELLOWSHI P APPLICATION
APPLICANT INFORMATION
Name:
Date of birth:
Native Language:
Phone:
State:
ZIP Code:
Country of Citizenship
Email address:
Mailing address:
City:
Please indicate how you learned about the Riley Fellowship
ACY Website;
ACY Staff;
Faculty Advisor;
Ad at School;
Other: ( please
explain )
ACADEMIC PROGRAMS
PLEASE LIST THE MOST RECENT 3 COLLEGES/UNIVERSITIES ATTENDED, PUTTING THE MOST RECENT FIRST
College /University
City
State
Country
Student Status
Attended From-To
Program of Study
GPA
Degree Earned/Expected
Date Degree Awarded/Expected
College /University
City
State
Country
Student Status
Attended From-To
Program of Study
GPA
Degree Earned/Expected
Date Degree Awarded/Expected
College /University
City
State
Country
Student Status
Program of Study
GPA
Attended From-To
Degree Earned/Expected
Date Degree Awarded/Expected
EMPLOYMENT INFORMATION
Current employer:
Position:
Employer address:
How long?
Previous employer:
Position:
Address:
How long?
Previous employer:
Position:
Address:
How long?
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ANNE RILEY FELLOWSHI P APPLICATION
Personal Statement
Please submit a 1-2 page statement explaining your reasons for wanting to do a policy fellowship at ACY.
Describe your experience working in the policy field, doing research or working on programs related to child well
being in the areas of child and family health, child welfare, education or juvenile justice. Please explain what you
hope to get out of your work at ACY, your area of policy in terest, and a brief statement about how you see this
helping you toward your career goals.
Vita/Resume
Please submit a current curriculum vita or resume.
Signature of applicant
Date
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