Prospective Applicant Form
Fellowships Office, Dewey 4-209B, 585-276-5869, fellowships@rochester.edu
First Name *
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Graduation Year *
Your answer
UR Student ID *
Your answer
Major(s) *
Your answer
Minor(s)
if applicable
Your answer
Email address *
Your answer
Phone number *
Your answer
Citizenship *
Your answer
State of legal residence
If applicable
Your answer
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?
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/
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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):
ON-CAMPUS ACTIVITIES
Your answer
OFF-CAMPUS ACTIVITIES
Your answer
Academic awards, other honors, special recognitions (give date & sponsor):
Your answer
International experience, past / future (indicate what program, where, when, how long):
Your answer
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):
Your answer
Awards of Interest
Check as many as apply. See http://www.rochester.edu/college/studentfellowships/ for more information about these awards.
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