UMKC School of Graduate Studies
Fellowship Application Form for 2016-17
School of Graduate Studies
Graduate Opportunity Fellowship
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When finished, you can save a copy of this Word document to a disk.
Eligibility requirements: Applicants must be degree-seeking doctoral students (Ph.D., Ed.D., D.M.A.), who are U.S.
citizens who are members of a federally recognized U.S. racial/ethnic minority group or have a federally recognized
disability, and who are admitted or enrolled in a doctoral program at UMKC for the 2016-17 academic year. Students who
plan on graduating before Spring commencement of 2017 are NOT eligible for this award program.
In addition to this completed application form, the following materials must be included:
 Transcripts of previous work; for continuing UMKC students, supply only a UMKC transcript. In Pathway’s “Self
Service,” there is an option in “Academic Records” to request an unofficial transcript to be sent to your university email
address, rather than paying $10 for the official copy.
 Three faculty recommendation letters.
Please indicate below the names and addresses of the three persons whom you have requested to complete the faculty recommendation letters:
1.
2.
3.
PERSONAL, ACADEMIC AND EMPLOYMENT INFORMATION
Last (print above)
First
Middle
Student I.D. Number
Address (street, apt. #)
City, State, Zip Code
E-mail Address
(
)
Phone
ETHNIC ORIGIN or DISABILITY STATUS (required)
International Student
Asian/Pacific Islander
Native American (tribal affiliation:
)
Black, Non-Hispanic
Caucasian
Other
Physical Disability
Hispanic
STATUS FOR FALL 2015:
New student
Continuing graduate student
If continuing
student:
a: What is your anticipated date of graduation?
b. Name of your major advisor:
Degree Program:
If you are an interdisciplinary Ph.D. student, please list your coordinating unit AND your co-discipline
 Applications without all required materials (including recommendation letters) will not be accepted.
 Do not staple any documents—just gather all materials in a letter-size manila envelope.
 Do not include over-size documents such as music compositions or bound booklets.
 Do not include copies of publications—just list them where indicated on the second page of the application form.
 Do not print on the back side of any pages.
 This application and all supporting documents are due to the School of Graduate Studies by
Friday, November 20, 2015 at 5:00 pm.
 Deliver to the School of Graduate Studies, Administrative Center (5115 Oak Street), Room 300F.
 If mailing, send to: UMKC School of Graduate Studies, 5115 Oak Street, AC 300F, Kansas City, MO 64112
PREVIOUS DEGREES AWARDED
DEGREE
DATE COMPLETED
DEGREE-GRANTING INSTITUTION
GRADE POINT AVG.
CURRENT EMPLOYMENT STATUS
Current place of employment and position:
Full-time
Part-time Does employer provide tuition assistance?
What are your employment plans for the 2016-17 academic year?
HONORS, AWARDS, OTHER SPECIAL RECOGNITION RECEIVED:
SPECIAL TALENT, LIFE EXPERIENCES OR OTHER CHARACTERISTICS, WHICH ENHANCE YOUR
GRADUATE WORK:
PUBLICATIONS AND/OR PRESENTATIONS AT PROFESSIONAL MEETINGS OR CREATIVE/ ARTISTIC
PERFORMANCES OR EXHIBITS IN YOUR FIELD(S) OF STUDY. If you are not the first or single author on a publication,
please list your role. Also include an accurate citation for the publication.
APPLICANT’S PLAN FOR THE FELLOWSHIP PERIOD If you receive a fellowship for 2016-17, how do you plan to use
your fellowship time to enhance your graduate experience? [Include here specific research plans, amount of time to be spent on campus in
discipline-related activities, education experiences you would not be able to pursue without the support of the fellowship stipend, etc.]