Project made possible by Kathryn Wasserman Davis for the “Davis Projects for Peace” Initiative

Entry Form to be filled out by individual participant (if group project, each group member needs to fill an entry each)

Last Name: ______First Name ______

Country of Birth: ______Country of Citizenship______

Culture(s) you were raised in: ______

I-House Room Number: ______E-Mail Address (Please print): ______

Phone: ______Social Security # (if applicable): ______

Field of Study/Concentration:______

Degree & Expected Completion Date:______

Occupation (if applicable): ______

Current I-House Graduate Resident: _____ Visiting Scholar: ______Undergraduate: _____

Other______

Date of first arrival at I-House: ______

Please list I-House Scholarships including date and amount received: ______

Please list I-House programs and activities you have participated in as a resident including any leadership roles/positions:

______

Title of your Project for Peace:______

______

I, undersigned, certify that this is my original project. I hereby give non-exclusive rights to International House for other uses of the project in all languages, throughout the world, in all media. This includes, but is not limited to, the right to edit, publish, reprint, and distribute copies of this project without compensation or notice. It is understood that I-House will acknowledge authorship of the project.

Signature______Date______

PROGRAM OFFICE STAFF

Date received:______Time received: ______

Designation: ______

Single Project: Yes_____

Multiple-authors project: Yes______(If multiple-authors project, have each author sign an individual entry form and clip all entry forms together)

Please check the following:

- Project summary (1 page ): ______

- Project proposal (max. 2pages): ______

- Project budget (one page): ______

- One-page resume: ______

- Is this entry form signed?______

- Have you given a receipt______

Staff initials: ______

Result: ______

Comments:

Pink: I-House Berkeley deadline

Green: New York deadline

Date / Action
Fall 2015 / • Promotion of Projects for Peace within each I-House
October 17, 2015 / • Grant Agreement forms due to I-House New York
Fall 2015: October 11, 2015 / Sunday Supper Announcement
January 11, 2016 by 4:00PM / Proposals submitted electronically to & in person to obtain a receipt at the Program Office (Larnie Macasieb)
January 12, 2016 / Program Office mailing packets to judges
January 21 (Thursday), 2016
9:30-11:30 AM Homeroom / Judging at I-House- second day can be oral interview
January 22 (Friday ), 2016
2-4 PM Homeroom or Executive Office / Oral interview
January 25, 2016 / Mailing selected proposal to NYC
January 29, 2016 / • Proposals electronically submitted by I-House coordinators to IH New York
March 14, 2016 / • Final decisions rendered by Davis UWC Scholars Program
March 19, 2016 / IH All grant payment letters signed because of Spring Break following week
March 23, 2016 / • Project Funding Agreements for I-Houses and resident members due to I-House New York
April 2016 / • Davis UWC Scholars Program will finalize selection of any alternate proposals to be funded
  • Grant Funds distributed

Week of July 13 no later than July 18, 2016 / Mid-point report 2016 due
May-August 2016 / Projects completed
August 26, 2016 4:00 PM / Final report due hard, soft copy, and disc
September 4, 2016 / Mailings to NY
September 9, 2016 / • Final report discs due to I-House New York

Please include your summary sheet (1 page), project proposal (max. 2 pages), project budget (one page), and a one-page resume. Return by 4:00 PM January 11, 2016 electronically to and in person to the Program Office to receive a receipt. For additional questions please contact Jason Patent, at - Telephone: 510-642-9460