PolNet 2019 - Fellowship Application
* Required
First Name
*
Your answer
Last Name
*
Your answer
Gender
*
Female
Male
Prefer not to Answer
Other:
Race/Ethnicity
*
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
White
Hispanic or Latino
Prefer not to answer
Other
Grad Student/Faculty Indicator
*
Full Professor
Associate Professor
Assistant Professor
Post-doctorate
Graduate Student
Undergraduate Student
Exhibitor
Other:
PhD Year or Expected
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Your answer
PhD Granting Institution
Your answer
Current Affiliation
*
Your answer
Address Line 1
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Your answer
Address Line 2
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City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone
*
Your answer
Email
*
Your answer
Confirm Email
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Your answer
Indicator of Whether Applicant is a US Citizen or Legal Resident
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US Citizen
Permanent US Resident
Non-citzen of the US
I have a submitted a conference proposal
*
Yes
No
If you have submitted a conference proposal, please state the title below:
Your answer
Statement about seeking funding <500 words
*
Your answer
In the space below, write the name of the mentor or supervisor who will submit a letter of reference on your behalf:
Your answer
*
I have instructed my letter writer(s) to submit a letter of recommendation on my behalf to
polinetworksconference@gmail.com
no later than February 25, 2019. My letter writer understands the subject of the email should say “Letter of reference for [last name]” and that the letter should be included as an attachment in Word or PDF for where the file is called [LAST NAME_LETTER].
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