Submit materials to:
Your school’s
associate dean via your
faculty advisor or
graduate affairs staff.
FLETCHER JONES FELLOWSHIP – AY 2015-2016
STUDENT INFORMATION FORM
Please reference Fletcher Jones Fellowship for more information.
STUDENT
INFORMATION
INSTRUCTIONS: Students interested in applying for the Fletcher Jones Fellowship should complete this form, save
the completed copy (with all information included), print and sign it, and send the completed MS Word file,
printed/signed form, and a current curriculum vitae to their program’s graduate affairs staff. The student’s faculty
advisor, department chair/program advisor and school associate dean must review the form and provide a letter of
recommendation. Final nomination packets (including this form) will be submitted to the Graduate Division office by
the school associate dean no later than Tuesday, September 1, 2015.
Student Name (Last, First Middle):
Address:
City, State and ZIP:
Student ID # :
Student e-mail address:
Dept/Academic Program:
Expected Date of Degree:
GPA:
Student Phone: (
)
Degree Objective:
Ph.D.
-
Citizenship:
Faculty Advisor:
Educational and Career Objectives:
STUDENT STATEMENT
OF FINANCIAL NEED
Please provide a Statement of Financial Need below of approximately 100 words. Please note that if you have applied for and
accepted Financial Aid loans or Work-Study awards and subsequently receive any fellowships, the additional support may affect your
eligibility for need-based financial aid. Please contact the Office of Financial Aid and Scholarships to determine if your eligibility will
be affected. Please review the terms of any funding that you have accepted for AY 2015-2016 to ensure that you are eligible to
receive additional fellowship funding.
STUDENT PROFILE
Please provide a biographic Student Profile below of approximately 100 words. Include, where applicable, undergraduate university
and previous degrees, research interests, current projects, honors, work experience, outside interests, and any special characteristics or
activities.
STUDENT RESEARCH
Please provide a 1-page Student Research statement describing your research project, written for a committee of non-specialists in the
field. The statement should include progress to date and plans for completion.
UCI Graduate Division
(To be completed by the student)
Revision date: 02/15/2016
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REQUIRED SIGNATURE
Late or incomplete applications/nomination packets will not be considered.
I understand that if I am awarded a Fletcher Jones Fellowship, I give permission to the Graduate Division and the University to use
my personal information and any photographs for the purpose of promoting graduate education at UCI and/or informing the
community as to the use of the Fletcher Jones Fellowship as it pertains to me. I also agree to participate in presentations and
discussions with community members regarding my research.
Student Name
UCI Graduate Division
Signature
(To be completed by the student)
Date
Revision date: 02/15/2016
Page 2 of 2