Fellowship Requests for Businesses
Academic Research Connections
FELLOWSHIP REQUEST FORM
Please complete the form on the left to request Academic Fellowships for student(s).
Make sure all the fields are completed.
Please note that Academic Research Connections will charge your company a service fee for services rendered. The service fee will vary depending on the contract with each company. I
Business Requesting Academic Fellowship:
Name of Individual in Charge of Fellowship Students:
Business Address:
City:
State:
Zip Code:
E-Mail Address:
Phone Number:
Contact & Billing Information
(This is the individual who Academic Research Connections will invoice so that the funds will be available to pay the students their fellowship stipends.)
Contact Name:
Billing Address:
City:
State:
Zip Code:
Billing E-Mail Address:
Billing Phone Number:
Fellowship Student Information
(Please provide the following information for the fellowship students who will be serving an acedemic fellowship for your company:
Name - Start Date - End Date - Hours Per Week - Stipend Per Hour or Stipend Per Week. Please enter this information in the textbox below. Press enter after each individual entry. See the example provided.)
IMPORTANT: PLEASE READ
In addition to the required information above, please send a letter written on your company's official letterhead stating the following information:
Terms and Conditions of the Academic Fellowship
Fellowship Students' Names
Start and End Dates for Each Student
Hours Per Week for Each Student
Stipend Per Hour or Stipend Per Week
Please send this letter as an attachment in a Word Document to Julene Messick
