Application


Name: __________________________________________________________________________
(Last) (First) (Middle)

Address: ________________________________________________________________________
(Street, Apartment or P.O. Box Number)

________________________________________________________
(City, State, and Zip)


Phone ( _____ ) ________________________ Phone ( _____ ) __________________________
(Office) (Home)

Email address: ______________________________________________________

Do you have active status in a terminal degree program? _____ Yes _____ No

If yes, please complete the following:

Program _______________________________________________________
(MA, PhD) (Department)

University _________________________________ City __________________ State __________

Expected date of degree completion _________________________________________________
(Month, Year)

Please indicate your current situation:

___ Taking course work in a doctoral/terminal program

___ Have completed required course work in a doctoral/terminal program, but have not passed oral exam

___ Have passed oral exams and working on doctoral dissertation

___ Other (please explain)

___________________________________________________________________________


___________________________________________________________________________


Name of your major ________________________________

Adviser: __________________________________

Major adviser's mailing address:

_________________________________________________________________


Major adviser's phone number: ( _____ ) _________________________________


Do your future plans include teaching in higher education? _____ Yes _____ No

Do you have college or university teaching experience? _____ Yes _____ No

If yes, please describe:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________


As a teaching scholar, what course(s) for undergraduate students are you most interested in and/or best prepared to teach?

Most Interested Best Prepared


___________________________________ ___________________________________


___________________________________ ___________________________________


___________________________________ ___________________________________

Signature of Applicant: _____________________________________________________


How did you learn about this fellowship?


Advertisement (Source) _________________________________


Posting (Where Posted) _________________________________


Other (Please Specify) __________________________________

NOTE: This application must be accompanied by:

* A cover letter and curriculum vita describing your research area(s), experience and qualifications.

* A copy of your graduate transcript. (This can be a copy of the official transcript)

* A letter from your major or dissertation adviser regarding your qualifications for this program.

* A letter from at least two additional references regarding your experience and ability.
(If you have teaching experience, letters should include relevant information.)

Send this application and related materials to the university of your choice. You are permitted to apply to more than one university but you must send separate copies of material to each school.

*** Please note that FDI Scholars may undergo a criminal background check as part the hiring/selection process at each university ***