for Business and Government
M-RCBG Fellows Program
79 John F. Kennedy Street
Cambridge, MA02138
Mossavar-RahmaniCenter for Business and Government
Senior Fellows Application
Deadlines
For those interested in CBG Fellow status beginning in September: April 1 for international applicants
May 1 for domestic applicants
For those interested in CBG Fellow status beginning in February: October 1 for international applicants
November 1 for domestic applicants
Applicant Information
Full legal name:______
First NameFamily/Last Name
Academic year for which you are applying:______
Period of Fellowship:
□ Full academic year (September 1-June 15)□ Full academic year (including summer term, June 15-August 15 )
□ Fall term (September 1-January 15)□ Spring term (February 1-June 15)
List the Center for Business and Government faculty member(s) you have contacted (in person or by mail):
______
All CBG Fellows have a Faculty advisor. Is there a Faculty member whom you’ve identified a potentially aligning with your research interests? ______
Indicate any grants or other funding expected:______
Name of persons recommending you: 1.______
Position/title: ______Institution:______
Phone: ______E-Mail: ______
2.______
Position/title: ______Institution:______
Phone: ______E-Mail: ______
Current mailing address:
______
______
______
______
Good until:______
E-Mail address:______
Telephone numbers:
Daytime: ______
Night:______
Permanent mailing address:
______
______
______
______
Gender: □ Male □ Female
Birthdate: ______
month day year
Social Security #:______
(Fill in this information only if you have spent time in the U.S. and if you applied for and received a U.S. Social Security Number)
Place of birth: ______
city, state/ province/ region
Citizenship: ______
Permanent U.S. resident: □ yes □ no
Current or former Harvard affiliation:______
Harvard ID: ______
Residency and Fees*
CBG Fellows apply to be Resident Fellows, and in exceptional cases can be Non-Resident Fellows. Resident Fellows have use of an individual cubicle space, equipped with a computer, telephone and a shared printer. Non-resident Fellows have access to a shared office area and shared computer access. Please note that “Residency” refers to office space only and does not refer to housing.
Residency Fee:$2,750 Fellows Fee plus
Government and Self-Sponsored: $5,500 Facilities Fee
Corporate Sponsored:$13,750 Facilities Fee
Non-Residency Fee:$2,750 Fellows Fee
*Fees listed are per semester
Please indicate residency preference: □ Non-resident □ Resident
If you wish to be considered for Non-Residency status, please provide a brief explanation:______
______
Education—List all post-secondary academic institutions attended, degrees received, and dates:
College/University
/Location
/Years Attended
From To / Field of Concentration /Degree (received or expected)
Type Date
Please list most important published articles and books or other research in your career to date:
______
______
______
______
______
Professional work experience—Most recent first. (You may submit your curriculum vitae or resume).
Position/Title
/Organization and Location
/Dates
To be completed by practitioners (those in non-academic positions):
What are the primary job responsibilities of your current position?
______
______
______
______
______
______
______
______
______
What is the biggest challenge facing your organization today?
______
______
______
______
______
______
______
______
______
______
Summary of Research Plans:
Please provide a concise summary of your research proposal. This should be approximately 150 words.
Research Proposal:
In three to five pages, summarize in English your research proposal, indicating specific research or project objectives, possible timetable, resources needed, and individual faculty members you hope to consult. If appropriate, include titles of any courses you hope to audit (course offerings at the KennedySchool may be found at the following web-site:
courseintro.htm). Indicate why you have chosen theMossavar-RahmaniCenter for Business and Government to accomplish your proposed research objectives.
Short Biography and Curriculum Vitae:
Lastly, please include a one-page biography and your curriculum vitae or resume.
I certify that the information provided on this application is accurate, complete, and honestly presented. I understand that any inaccurate or misleading information or omission will be cause for disqualification from further consideration for admission and will be cause for the rescinding of any offer of admission, or for dismissal from the Fellow status if discovered at a later date. I further acknowledge that I have read the Fellow information provided with this application, and that I understand that I am applying for neither degree status, nor a faculty appointment.
SIGNATURE______DATE:______
Please return all application materials to:
M-RCBG Fellows Office
79 John F. Kennedy Street
Cambridge, MA02138
Applications can also be sent electronically to:
SUPPLEMENT FOR INTERNATIONAL APPLICANTS
English Proficiency
How many years have you formally studied English?
______
Do you speak English in your professional work? □ yes □ no
If yes, how frequently and for how many years? ______
______
Please rate your English abilities in the following areas (use the following descriptions: Fluent, Conversant, Sufficient, Needs work):
Reading______Writing______Speaking______Listening______
Visa Information
What is your current visa status (if any)?______
Are you planning to apply for a Harvard-sponsored visa? □ yes □ no
If no, indicate which institution is sponsoring your visa: ______
Marital status: □ married □ unmarried
If married, will your spouse (and/or children) accompany you in the U.S.? □ yes □ no
When will your spouse (and/or children) join you?______
Please give the following information on each dependent who will accompany you to the U.S. or join you later:
Name
______
______
______
______
Relationship
______
Date of Birth
______
Place of Birth
______
Citizenship
______
Have you ever been in the United States before? □ yes □ no
If yes, give dates:______visa status:______
dates:______visa status:______
Financial certification: If you are admitted to HarvardUniversity as a CBG Fellow, and request a Harvard-sponsored visa, you will be required to submit this office proof of funds available for your support at Harvard.
Please indicate your source and amount (in U.S. dollars) of financial support and return the information below with your application.
□ Personal funds / Amount US$______/ Deposited in which U.S. bank?______/ anticipated □
confirmed □
□U.S. Government Agency / Amount US$______/ Deposited in which U.S. bank?
______/ anticipated □
confirmed □
□ Foreign Government / Amount US$______/ Deposited in which U.S. bank?
______/ anticipated □
confirmed □
□ Other organization / Amount US$______/ Deposited in which U.S. bank?
______/ anticipated □
confirmed □
□ Other / Amount US$______/ Deposited in which U.S. bank?
______/ anticipated □
confirmed □
TOTAL AMOUNT OF ALL SUPPORT US$______
Full year for individuals must equal minimum $30,000 and $34,000 plus the CBG fellows fee.
Full year for individual coming with a spouse must equal $35,000 and $38,000 plus the CBG fellows fee.
Please note that individuals who are being sponsored by an organization or agency must supply this office with an official document providing the award and stipulating the terms of the award with specific dollar amounts, and dates of tenure.
I hereby certify that the information given by me on this financial certification is accurate in every respect, and I understand that any misrepresentation may be cause for denial or revocation of admission.
Signature______Date______