Prospective Applicant Form
Fellowships Office, Dewey 4-209B, 585-276-5869,
UR Student ID
State of legal residence
If not a U.S. citizen, are you a permanent resident of the U.S.?
If you are seeking citizenship, when do you expect to become a U.S. citizen?
Extra & Co-curricular activities (e.g., social, cultural, academic clubs/organizations, student government, RA, TA, community service, athletics, performing arts, internships; Indicate any leadership positions held and period of involvement):
Academic awards, other honors, special recognitions (give date & sponsor):
International experience, past / future (indicate what program, where, when, how long):
Post-graduation plans / career aspiration (e.g., Ph.D. in history, M.A. in urban planning, M.D., J.D. / professor, high-school teacher, public official, physician, environmental engineer, epidemiologist):
Awards of Interest
Check as many as apply. See
for more information about these awards.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service