David C. Frederick Public Service Award / Application
COVER SHEET

PLEASE TYPE OR PRINT

I. Background Information
first name / peoplesoft
number
last name
mailing address / phone / - / -
city / state / zip / e-mail address
Name of 1st Reference (To provide letter) / major (s)
Email / Minor(s)
Phone / Certificates(s)
Name of 2nd Reference (No letter needed) / expected term of graduation
Email / cumulative gpa
Phone
II. Instructions

Submit all application materials listed below to Andrew Lotz, PhD, Lecturer and Academic Advisor in the Department of Political Science .

o  Application: Combine the following items into a single PDF document to be attached to an application email, in the following order:

o  COVER SHEET: Fill out the boxes above and sign below. Use this page as the cover sheet for your application.

STATEMENT OF INTEREST: An essay of 750-words or less.

o  Tell us what type of internship you are interested in. (You may including potential noprofit organizations or government agencies, U.S. cities or regions, or topic areas.)

o  Discuss how this public service internship award will further your academic goals, and how public service fits into your broader life trajectory.

ACADEMIC RECORD: Current transcript (may be unofficial)

o  1-PAGE RESUME

Letter of Reference: A letter from one of the above-named references should be submitted to Andrew Lotz, PhD, Lecturer and Academic Advisor in the Department of Political Science .

I, the undersigned, understand that receiving this fellowship means that I am willing to attend future meetings with David C. Frederick and the award committee, and to submit a final report and/or presentation on my Summer Public Service Internship experience.

______

Student Signature Date