2012 grad application form.pdf

Dwight David Eisenhower Transportation Fellowship Program

2012 Eisenhower Graduate Fellowship Application

Application Form - Part 1 Must be typed

Name (Last, First, MI) For Official Use Only:

Current Address Telephone No.:

E-mail Address:

Alt. Number:

Permanent Address Telephone No.:

Check the box which represents your status as of 9/1/2012:

___ Masters Degree ___ Doctorate Degree Year of Study __________ (i.e. . 1st,2nd ) Current Grade Point Average ___________

RACE (optional) __ American Indian __ Alaska Native (Aleut or Eskimo) __ Asian __ African American/Black __ Native Hawaiian/Other Pacific Islander __ White __ Other ETHNICITY (optional) __ Hispanic or Latino __ Not Hispanic or Latino __ Hispanic or Latino in Puerto Rico __ Not Hispanic or Latino in Puerto Rico

Gender:

__ Male __ Female

U.S. Citizen __ Yes __ No - If no, please attach a certified copy of your I-20 or I-551 ID issued by the C.I.S.

College or University (Current or Pending) Academic Dept.

Name, Title and Address of Faculty Advisor

Telephone No.:

E-mail Address:

Applicant's Major Applicant's Field of Study

Date Signature of Applicant (Required)

Date Signature of Faculty Advisor (Required)

Application Form - Part 2

Colleges/Universities Attended

Dates Attended

Degrees Earned

Date Awarded

Employer (most recent first) Address Name of Supervisor and Telephone No.

Dates of

Employment

From:

To:

From:

To:

List Academic Honors, Scholarships, Offices Held in Student /Professional Organizations, etc.

Community Activities/Organizations:

Experience in Transportation Education Programs

__ ENO Fellow Year _____ __ UTC Award Year _____ University Transportation Centers __ DDE Fellowship Year _____ Dwight David Eisenhower Transportation Fellowship

__ STIPDG Year _____ Summer Transportation Intern Program for Diverse Groups __ NSTI Year _____ National Summer Transportation Institute __ Other Year _____ Name

Application Form - Part 3

Proposed Plan of Graduate Study Please provide a summary of how your plan of study will impact and enhance the field of transportation and what role transportation takes in your professional goals. Incorporate educational, personal and work experiences, accomplishments, volunteer activities and/or events that support your plan of study. Limit 2 pages.

2012 DDETFP Applicant Checklist (Keep This Page for Your Records)

Dear Applicant:

This letter is provided in an effort to ensure that all information is submitted in a timely manner.

Incomplete packages will NOT be considered. Please pay attention to all deadlines and information.

Prior to sending your packet to Universities and Grants Programs, 1310 North Courthouse Road, Suite 300, Arlington, VA 22201, ensure that you have reviewed your application thoroughly and are confident that all materials are enclosed.

If you would like confirmation of delivery, provide a Postage Paid Postcard w/ your return address.

Application Items

- Citizenship _____

- 2 Copies of Application Packet _____

- Contact Information _____

Phone Number _____

E-mail _____

Faculty Advisor Signature _____

Applicant Signature _____

Official University Transcripts _____

Letters of Recommendations(4); (Any less than required results in incomplete application) _____

Resume/CV _____ Full Academic Year Remaining (See Eligibility Requirements)

** Applications and all supporting materials are due by 5:00p.m. February 10, 2012 **

NO Exception!!

Comments:

This page last modified on October 11, 2011

Application Form - Part 2Must be typed

Application Form - Part 3Must be typed