HENRY FELLOWSHIP
YaleUniversity
Application Form
______
Date ______
1. Name in full ______
Last First Middle
Student ID#: ______
2. Present mailing address ______
ResidentialCollege or street address ______
______Phone ______
3. Permanent home address ______
4. Phone ______
5. E-Mail Address ______
6. (a) Date and place of birth ______
(b) If naturalized, how and when did you become a citizen of the U.S.?
______
7. Marital status ______
8. University and degree course proposed for the Henry:
______
*Attach a description of your proposed course of study in England. If you propose original research, outline your plan. If you contemplate staying on after the Fellowship year to take a higher degree, please indicate. Be as specific as possible about what you want to achieve during the year, but it is not necessary to list the exact courses that you would take. USE NO MORE THAN 1000 WORDS.
9. Secondary (high school) attended:
(a) List school, giving location and dates of attendance.
______
______
(b) List any positions of authority you held, distinctions you attained, and sports or school societies in
which you participated.
______
______
______
10. Colleges or universities attended. List institution(s) and degrees, with dates:
______
______
*Attach a one to two-page résumé giving the details of college/university activities, honors, awards, recreational and extracurricular interests and activities, including leadership roles.
11. You may attach a sample of written work or a publication related to your proposed field of study.
If you choose to provide a sample of written work, please describe it briefly:
12. List any extracurricular activities in which you might wish to participate during the Fellowship year.
13. What are your career plans after the year of the Fellowship?
14. Give any other information likely to be of interest to the Selection Committee or to the Trustees of the Henry Fund.
15. (a) Have you applied for admission to either Cambridge or Oxford?
Yes ______No ______
What is the current status of your application?
______
______
If you have applied to more than one degree course, which would be your first choice?
______
(b) Have you applied for any other scholarship or fellowship for study in a university?
Yes ______No ______
If so, give details, including current status of application(s).
______
______
16. List the names, titles, and addresses of three persons from whom you are requesting references.
(1) ______
______
(2) ______
______
(3) ______
______
It is understood that I may not read the letters of recommendation I have requested for the Henry Fellowship, and that I will not seek to do so either while I am enrolled at Yale, or subsequently.
Signature: ______Date:______
Signature to indicate that this application for the Henry Fellowship is approved and supported by the Dean of your Residential College:
______
Applicant’s name
______
College Dean's Signature
______
Applicant's Signature
APPLICATION NOT VALID UNLESS SIGNED BY APPLICANT
Last revised by Fellowship Programs, autumn 2011