Grants for Pre-Dissertation Research

2017-18 Education Statement for

Endowed Fellowship Competitions:

Brand/Johnston/Kunze/Leonard/Miller

Indicate which application(s) you are applying for:

Requires Application Submitted by Student:

Brand: Johnston: Kunze: Leonard Film: Miller:

Name (Last, First): / UMN Student ID:
Current UMN Graduate Program: / UMN Graduate GPA:
Term of Entry to Program (e.g., Fall 2015): / Date Prelims Passed, if applicable (MM/YYYY):
Written:
Oral: / Proposed Term of Graduation
(e.g., Spring 2020):

Graduate Institution(s): Major/Degree Earned: Year: GPA:

1.
2.
3.

Undergraduate Institution(s): Major/Degree Earned: Year: GPA:

1.
2.
3.

Adviser Name: Email:

Co-Adviser (if applicable) Name: Email:

Does the research involve Animal or Human Subjects? Yes No

If yes, indicate status of IRB/IACUC approval: (see FAQ)

Pending

Waiver obtained:

Approved: Date approved:

The applicant may voluntarily waive the right to inspect letters of recommendation, thus assuring recommenders that the letters will remain confidential. The applicant may decline to sign the waiver.

I waive my right to inspect letters of recommendation.

I do NOT waive my right to inspect letters of recommendation.

I certify that the above information is complete and accurate to the best of my knowledge and that I have attached all supporting documents requested in the instructions. If awarded a Fellowship, I will not hold concurrently any supplemental appointment, award or employment which exceeds the value of a 25% assistantship, without prior approval of the Graduate School Fellowship Office and attendant reduction in the Fellowship stipend.

Applicant Signature: ______

(Typed signature is acceptable)

GSFO 7/29/2016