2016– 2017 PITTSBURGH SCHWEITZER FELLOWS PROGRAM APPLICATION

Application Deadline: Friday, February 12, 2016

Visit our website at

Learn more about Dr. Albert Schweitzer at:

For more information please contact:

Joan Haley, Executive Director: 412.363.0185 x26 or

For details on Traditional and Environmental Fellows, please visit:

Application Submission:

Applications can either be sent as an email attachment to or snail-mailed to:

Joan E. Haley

Pittsburgh Schweitzer Fellows Program

5614 Elgin Street

Pittsburgh, PA 15206

Applications must be received no later than

5:00pm on Friday, February 12, 2016

I am applying to the Pittsburgh Schweitzer Fellows Program to be considered for a:

____Traditional Fellowship ____Environmental Fellowship ____Either Fellowship.

(We will consider you

in each category.)

Demographic Information

First Name: Last Name:

Address:

City:

State:

Zip:Phone:

Primary Email Address: Secondary Email Address:

Will you be enrolled in a degree-granting graduate program through April 2017? Yes No

What year in your degree program will you be during the 2016-17 academic year?

When is your expected graduation date?

School: Discipline: Degree Program:

Optional Section: Dual Degree Students

If you are a dual degree student, list other school:

If you are a dual degree student, list other discipline:

If you are a dual degree student, list other degree program and expected graduation date:

Paired Applicant Information (Both partners need to submit an application )

If you are planning to apply as a pair, please indicate the name of your partner?

Fellows are required to participate in Fellowship activities throughout the year (April 1, 2016-April 30, 2017).

Will you have any significant responsibility during the Fellowship year that may interfere with your ability to participate in the Fellowship? Yes No If yes, please describe.

Please indicate any dates you anticipate being out of the area more than 6 weeks and unable to participate in Fellowship activities for reasons other than those listed above:

Project Information

  1. Target Population(s) for your proposed community service project, including demographic information, and a need that your project will address. (Suggested Word Count 150)
  1. Proposed Community Agency (if you have not identified a possible site, indicate “TBD”).
  1. Summarize your proposed community service project, including project goals and the actions you will take to meet these goals. (Suggested Word Count 350)

Note:

Applicants proposing to sustain an existing project supported by the Schweitzer Fellowship should explain why they are choosing to continue this particular project and the ways in which the project will be expanded.

Paired project proposal applicants should discuss why the project needs to be led by two people in order to succeed (as opposed to a project led by an individual). Detail the role of each partner.

Environmental Fellows Applicants need to indicate how their project will raise the awareness of their population regarding the environmental effects on health

  1. What is the time frame for your project? Please consult application guidelines for specific program start and stop dates. (Suggested Word Count 150)
  1. How do you propose to evaluate the project to determine whether your goals were met? (Suggested Word Count 200)
  1. Describe any thoughts you have about how the project might be sustained beyond your time as a Fellow. (Suggested Word Count 200)

Personal and Professional Information as it Relates to Fellowship Activities

  1. What are your motivations for applying to the Schweitzer Fellowship Program? (Suggested Word Count 200)
  1. Considering that there are many different types of community service projects a Fellow could design, what inspired you to develop your particular project idea? (Suggested Word Count 200)
  1. In a personal statement, please discuss the following: (Suggested Word Count 600)
  • Ways in which your participation as a Schweitzer Fellow would be meaningful to your personal and professional development
  • Skills and experiences you will bring to the Fellowship
  • What it might mean for you to belong to an alumni network of “Fellows for Life”
  • Any unique, personally important, and/or challenging factors in your background, and how they have influenced your goals and preparation for your career.

References and Resume

  1. Please list three references. At least one reference should be a faculty member from your school who could serve as your academic mentor for the Schweitzer Fellowship.

One person listed below (only one) needs to write a Letter of Recommendation on his/her letterhead stationery and send it to arrive by 5 PM February 12, 2015 to:

Joan Haley

Pittsburgh Schweitzer Fellows Program

5614 Elgin St.

Pittsburgh, PA 15206

Or e-mail it to:

For each reference, describe your relationship in one sentence and include their telephone number and email address:

Reference 1 - Proposed Academic Mentor:

Reference 2:

Reference 3:

Again, only one of the 3 references needs to write a letter of recommendation.

  1. Please list someone at your proposed site who could serve as a site mentor or who has been your site contact. Include telephone number and email address. (If a possible site mentor or contact has not yet been identified, please indicate “TBD.”)
  1. Please include a brief resume (no longer than 2 pages).