Student Name: Student ID:
Student Email:
Student Undergraduate and Masters (if applicable) GPA:
Program Name: Major Code:
School:
Staff Contact Person (if applicable): E-Mail Address: Extension:
Will the student be involved in research in which animals are used in [any] way as test subjects?
Yes
No
Unsure. Please explain:
A narrative outlining how the student meets the Fellowship criteria, explain why this Fellowship may persuade the student to attend UC Irvine. (1,000 word limit.)
Describe the competing offer(s) and attach documentation in the form of admission and/or financial support offer letters.
Please identify any UCI fellowships that the student has received or is still pending (i.e. DRF (list quarter), ECR, school fellowship, etc.):
Student Interview Confirmation (In order to be considered for this fellowship, the student must be interviewed during the admissions process by the department)
Faculty Interviewer(s) Name:
Date of Interview:
Method of Interview (Phone, In-person, Skype, etc. Email correspondence NOT acceptable):
Please state the amount requested in increments of $5,000 maximum $50,000:
Please check the boxes that correspond with the quarters you wish to request funding. Each box indicates an increment of $5,000 (this is the maximum that may be requested per quarter). Please note, the award may not be used in summer 2018 except for Competitive Edge participation:
AY 2017-18 AY 2018-19 AY 2019-20 AY 2020-21 AY 2021-22 AY 2022-23
☐ Summer* ☐ Fall ☐ Fall ☐ Fall ☐ Fall ☐Fall
☐ Winter ☐ Winter ☐ Winter ☐ Winter ☐ Winter
☐ Spring ☐ Spring ☐ Spring ☐ Spring ☐ Spring
☐ Summer ☐ Summer ☐ Summer ☐ Summer *Summer 2018 is only for Competitive Edge if they haven’t been awarded a DRF, ECR or GOF.
By signing this form, the Graduate Advisor or Department Chair agree to all stipulations of the fellowship.
Graduate Program Advisor or Department Chair Name (typed): Email address:
Signature (no stamps or signatures on behalf will be accepted)
Please submit in one completed PDF packet:
· This completed nomination form
· Copy of the student’s application (letters of recommendation and the application from DAVAD)
· Copy of student’s undergraduate (and if applicable, Master’s) official academic transcripts
· Copy of the student’s admission and financial offer letter
· Copy of competing offer letter(s)
Submission Instructions:
Submit nomination package to
The subject line and the name of the nomination file should include the name of the fellowship, last name of nominee and student ID number for the nominated student. An example would be “Nevin_Campos_12345678.”