ACADEMIC RESEARCH CONNECTIONS
Fellowship Application
(Fields marked with an * are required)
*Application Type (check one):
*Fellowship Applying for:
PART I: PERSONAL INFORMATION
*Full Name:
*Social Security Number:
Birthday:
*Mailing Address:
Permanent Address:
(Only if different than mailing address)
*Home Phone:
Cell Phone:
E-mail Address:
Citizenship: U.S. Citizen?
If no, country:
PART II: EDUCATIONAL INFORMATION
(High School, Undergraduate, and Graduate students complet Part 2A. Teachers, skip down and complete Part 2B)
A. HIGH SCHOOL/UNDERGRADUATE/GRADUATE STUDENTS ONLY
High School/Current Institution/University:
City:
State:
Zip:
Specialty Areas/Career Goals:
List up to 10 key words (or short phrases) that will help sponsors and employers understand your interests, skills and special qualifications to your field of study.
Grade Level:
Degree Program:
If other, type here:
Major:
Minor:
(if applicable)
Expected Graduation Date:
GPA:
*City:
*State:
*Zip:
City:
State:
Zip:
B. TEACHERS ONLY
Current School/Institution:
City:
State:
Zip:
School District:
Subject(s) Taught:
Specialty Areas/Career Goals:
List up to 10 key words (or short phrases) that will help sponsors and employers understand your interests, skills and special qualifications to your field of study.
PART III: RESUME
*Use this text box to write or copy and paste your current resume:
PART IV: AFFIRMATIVE ACTION INFORMATION
*The information you provide regarding, gender, age, ethnicity and disability is completely confidential and will be used for statistical purposes only. You are required to select one of the options below. If you choose to "answer this information" please select one option in each category.
Ethnicity:
If other, explain:
Gender:
Physical Disability?:
If yes, please explain:
PART V: REFERENCES
Please list two personal or professional references not living with you.
Title:
*Name:
*Address:
*City:
*State:
*Zip:
*Home, Work, or Cell Phone:
Title:
*Name:
*Address:
E-Mail Address:
Reference #1
Reference #2
*City:
*State:
*Zip:
*Home, Work, or Cell Phone:
*E-Mail Address:
PART VI: PRIVACY RELEASE INFORMATION
*By submitting this application, I authorize the release of application forms and attachments to federal agencies, participating federal, industrial, and educational entities, and cognizant review panels as needed by Academic Research Connections to facilitate the review and selection process of the award. Release of information will be in accordance with the Privacy Act of 1974 (Public Law 93-579) and the Family Educational Rights and Privacy Act (Public Law 93-3880).
In addition to submitting this application, please mail official transcripts to the address below.
Academic Research Connections
P.O. Box 376
Shelley, ID 83274
