Gluck Fellows Program of the Arts

GLUCK FELLOWSHIP APPLICATION FORM 2017-2018

APPLICATION FOR Outreach Program Family Learning (OPFL) FELLOWS:

ARTSBLOCK / MUSEUM EDUCATION / GluckTV / Social media OUTREACH

APPLICATION DEADLINE: MONDAY, May 15, 2017

Fill out this form and return as a Word Document to (Do not use Google Docs or return as a PDF.) PLEASE SAVE AS: OPFL_LastName_FirstInitial_17-18.doc (eg. OPFL_Smith_J_17-18.doc)

Advisory: Gluck Fellowships are available only for UCR Graduate and Undergraduate students. Fellowships are paid through Financial Aid. Please do not submit an application unless you are certain that you have the time to complete the requirements of your fellowship. Applications must be filled out completely; incomplete applications will not be accepted.

PLEASE TYPE DIRECTLY ON THIS FORM

I. CANDIDATE INFORMATION (All information is required to process this application. Please type directly on this form.)

Name (Last, First): SID#: 86 Preferred personal pronoun:

Stage Name (if different from legal name, please let us know how you would like to be called):

Telephone: E-mail:

Department: Major: Minor: Expected graduation date:

Student Standing: Graduate ___ Undergraduate ___

New Fellow: ___ Returning Fellow: ___
(Returning fellows must create a new program offering and may not repeat last year’s.)

If you are a returning UCR student, please list one UCR Faculty who can comment on your work:
Faculty Name: Department: Telephone:

Have you done CANRA Mandated Reporter online training? Yes ___ No ___
Mandated reporter online training is mandatory if you are selected.

Have you done LiveScan fingerprinting at UCR? Yes ___ No ___
We may institute mandatory LiveScan for each fellow.

If this is a joint/team or ensemble application, please give ensemble name and list each member:

Ensemble Name:

Member Names:

Each member in a Gluck Team or Ensemble must fill out their own Candidate Information, please combine documents with one Program Information section and send together.

II. PROGRAM INFORMATION

Please check the type of Fellowship you are applying for:

__ ARTSblock

__ Museum Education Leadership

__ Museum Education Support

__ GluckTV

__ Social Media Outreach

Program Title and Description:

Brief Biography: (please write in 3rd person)

Please include a comprehensive materials list and budget for your program – include photocopying, etc.

(Instructions on Page 10 of Application Pack)

Item / Quantity Needed / Cost / Amazon, etc. link - if applicable

Event Schedule: (your Gluck obligation) Please outline how you would envision each session of your fellowship.

I have read and understand the 2017-2018 Gluck Fellowship Outreach Program Family Learning Handbook. If selected to receive a Gluck Fellowship, I agree to fulfill the obligations required of Fellows participating in the Gluck Fellows Program of the Arts. I understand that any failure to comply with these obligations may result in jeopardizing consideration for future Fellowship opportunities.

Signature Date

In order to be considered for a Gluck Fellowship, you must return this form as a Word doc by email to:
Please save Word doc file as: OPFL_LastName_FirstInitial_17-18.doc
(eg. OPFL_Smith_J_17-18.doc)
Applications must be submitted no later than May 15, 2017.