Name First Last Pronouns Email Address Alternate Email Address Local Address Local Phone Number ###-###-#### Summer Address (if different) Summer Phone Number (if different) ###-###-#### Permanent Address (if different) Permanent Phone Number (if different) ###-###-#### Major(s) Minor(s) Advisor Current Year in School - Select -FreshmanSophomoreJuniorSeniorAlum Expected Graduation Date GPA I am a: U.S. Citizen International Student Permanent Resident/Green Card Holder Other Enter other… If you studied abroad, please indicate the location and terms/years. If you HAVEN'T studied abroad, but would LIKE TO, please indicate where and when you would like to go. If you are studying a foreign language, please list below with length of study. Describe your participation in community service, volunteerism, leadership activities, and extracurricular activities. Describe your participation in service learning courses (receive college credit for the course). Describe your participation in undergraduate research. What are your future plans and career goals and what have you done or plan to do to accomplish them? Name three things you feel genuine passion about or commitment to that relate to your career goals or scholarship aspirations. Name three experiences or interests that set you apart from your fellow students. Why are you interested in applying for a fellowship or scholarship? What else do you think we should know about you? Have you ever applied for a scholarship or fellowship before? Yes No If yes, please specify. Scholarships for Minority Students I am interested in scholarships for minority students. If you checked the box above, please indicate which minority group(s) you are interested in scholarships for. I would like to discuss the following fellowships/scholarships. ** minority scholarships Check all that apply. Boren Fellowship Boren Scholarship James C Gaither Junior Fellows program Davies-Jackson Ford Foundation Fulbright Gates Cambridge Barry M. Goldwater Hertz Foundation Howard Hughes James Madison Marshall Mellon Foundation George J. Mitchell NCAA Graduate scholarship** Newhouse** NPSC Rhodes Rotary Peace Fellowship Soros** Truman Udall Watson Judith Weidman** Wiesel Foundation for Humanity Unsure Other Please specify How did you hear about us? Check all that apply. Email message Fellowships website Class(indicate below) Workshop(indicate below) Advisor(indicate below) Faculty member(indicate below) Fellowships bulletin board Other(indicate below) If you marked Class, Workshop, Advisor, Faculty Member, or Other above, please specify. Please provide the names of at least three persons willing to write letters of recommendation for you. These people should be willing to serve as your advocacy committee and are usually faculty members. Waiver I acknowledge my obligation as a member of the Puget Sound community who subscribes to the university’s integrity code. I recognize my obligation to conduct myself responsibly and honorably throughout the application process, and to be fair, civil, and honest with all participants in the application process. I will be forthcoming with all information (both academic and personal) that may affect my ability to participate in the fellowship opportunity. I know the university nomination or support may be withdrawn if I do not abide by these provisions, or am unwilling or unable to complete the final stages of the application process, which may include substantial revision of the written application. I understand that information created and shared for the application process will be confidential, and shared only on a need-to-know basis with members of the Puget Sound community. I understand that the Fellowships Office may need to access my personal, conduct, and academic information. By signing below, I am giving the Fellowships Office staff members permission to do so, and they may share my name and information with appropriate faculty/staff as necessary to access that information. I waive my rights to view letters of recommendation, nomination letters and reviewer comments. I grant the Fellowships Office permission to use my name and photo to publicize my achievements. Electronic Signature Typing your name below serves as your electronic signature that the information above is accurate and that you understand the waiver information presented above.