APPLICATION FOR AWARDS
GRANTS, FELLOWSHIPS, SCHOLARSHIPS, TRAVEL
(By Announcement Only)
Purpose of Application:
Check one: ___Scholarship; ___Fellowship; ___Travel;
___Other: Please specify _________________________________________________________________________________________________
Name: _____________________________________________________________________________________________________________
Address: ______________________________________________________________________________________________________________
Telephones: _______________________________ ________________________________ _________________________________________
Email: ______________________________________________________________________________________________________________
Date of Birth_________________________________________
S/S #_____________________________________ (OR) Passport _____________________________________
Institutional Affiliation: ________________________________________________________________________
Education:
___________________________________________________________________________________________________________________________________________________________________________________________________________________
Experience:
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Brief Description of Proposed Activity and Time Frame (Use additional page if needed):
________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Expected Outcomes:
________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________
Resources being requested: ______________________________________________________________________________________________________________________________________________________________________
Signature___________________________ Date ____________________________
NOTE: Applicants must attach a one-page Personal Statement and supporting documentation including THREE references
................( 2 academic and 1 character).....................................................................................................................................................
Approved_____ Amount of Award $________ Not approved___
Signature___________________________________ Date _____________________
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John Smith, President
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