Check One: / U.S. Citizen Permanent U.S. Resident AB540
Student Name: / (Last) (First) (Middle) / Student ID #:
Address:
City, State and ZIP:
Student e-mail address: / Student Phone: () -
Academic Program: / Degree Objective: PhD
AWARD RECOMMENDATION / To avoid delays in nomination processing, please complete all sections of this form and submit the nomination package with all required documentation to the Graduate Division by the nomination deadline. (Nomination procedures and deadlines can be found at https://grad.uci.edu/funding/fellowships-awards/diversity-fellowships/graduate-opportunity-fellowship.php .
Multi-year recruitment fellowship offers involve an agreement between UCI’s Graduate Division and the student’s academic department regarding the type and level of financial support. In general, the student’s department or program is obligated to provide two or more years of support in the form of teaching assistantships, graduate student research appointments, and/or fellowships. All financial commitments are contingent on the student’s maintaining appropriate levels of academic performance and degree progress. Once awards have been made, the student’s program will be notified by the Graduate Division and the student’s award letter will be generated by the Graduate Division. Please refer to specific program standards, procedures and nomination information at https://grad.uci.edu/funding/fellowships-awards/diversity-fellowships/graduate-opportunity-fellowship.php Note: Fees for the 2018-2019 academic year have not been published. The nomination form reflects fees for the 2017-2018 academic year. Final award letters will reflect the 2018-2019 fees if they are available.
YEAR / Graduate Division Commitment / Academic Department Contribution / Total Student Award
Summer Stipend / Award
(After selecting an Award value, press Tab to recalculate) / Stipend/Award Amount
(After entering an amount, press Tab to recalculate) / Tuition/Fees
(After entering an amount, press Tab to recalculate)
Year 0*
(Summer 2018) / $5,000.00 / $5,000.00
Year 1
(AY 2018 – 2019 including Summer 2019) / Non-Resident TuitionSummer StipendBlock Fellowship/StipendExternal Fellowship/Grant50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionTravel StipendOther: / $0.00 / $0.00 / $0.00
Non-Resident TuitionSummer StipendBlock Fellowship/StipendExternal Fellowship/Grant50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionTravel StipendOther: / $0.00 / $0.00
Non-Resident TuitionSummer StipendBlock Fellowship/StipendExternal Fellowship/Grant50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionTravel StipendOther: / $0.00 / $0.00
Non-Resident TuitionSummer StipendBlock Fellowship/StipendExternal Fellowship/Grant50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionTravel StipendOther: / $0.00 / $0.00
Non-Resident TuitionSummer StipendBlock Fellowship/StipendExternal Fellowship/Grant50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionTravel StipendOther: / $0.00 / $0.00
Year 2
(AY 2019 – 2020 including Summer 2020) / $3,000.00 / Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00 / $3,000.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Year 3
(AY 2020 – 2021 including Summer 2021) / $3,000.00 / Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00 / $3,000.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Year 4
(AY 2021 – 2022 including Summer 2022) / $3,000.00 / Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00 / $3,000.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Year 5
(AY 2022 – 2023 including Summer 2023) / Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
Summer StipendBlock Fellowship/StipendExternal Fellowship/GrantTravel Stipend50% TA Employment/Fee Remission25% TA Employment/Fee Remission50% GSR Employment/Fee Remission25% GSR Employment/Fee RemissionLocal FeesOther: / $0.00 / $0.00
TOTAL MINIMUM AWARD: / $14,000.00
*Year 0 includes participation in the Competitive Edge summer program
Revision Date: 12/2017
MENTORING PLAN / Please attach a preliminary mentoring plan for this student.Please provide a preliminary mentoring plan for the student you are nominating for this diversity fellowship. This plan must detail how the student will be mentored in order to enhance the likelihood of degree completion. Mentoring can occur through the student’s interaction with the faculty advisor and through the student’s participation in departmental activities that are designed to enhance students’ academic success. Activities should be documented on a quarterly basis.
Since the student is still in the nomination process, this plan will be considered preliminary. This preliminary mentoring plan will be used for the purposes of reviewing the nomination and should be revised and finalized once the student enrolls. Should the student be awarded the fellowship, revisions to the mentoring plan must be completed and submitted to the Graduate Division by Friday of week three, fall quarter 2018.
Once the student has accepted the fellowship, the mentoring plan must be reviewed by the student and a faculty advisor on a quarterly basis. Each year a status report on the progress made throughout the year, as well as a new mentoring plan for the upcoming year will be due to the Graduate Division by Friday of week eight, spring quarter.
By nominating the student, the faculty advisor and/or department agrees to meet these reporting requirements and uphold the mentoring plan.
DEPARTMENT RECOMMENDATION / Attach a letter of support from the proposed faculty mentor and/or graduate advisor and/or program director. Below are requirements for the program recommendation
The program recommendation is one of the most important parts of the nomination packet. Here are the requirements when writing a letter of support for GOF.
· This needs to be written by the student’s proposed mentor (if available) and/or graduate advisor and/or program director.
· Summarize previous contact that you have had with the student.
· The following questions need to be addressed:
o Does the nominee meet the UC definition of diversity? If so, how? http://regents.universityofcalifornia.edu/governance/policies/4400.html
o Does the nominee show a commitment to diversity? What evidence in their application demonstrates this?
o Has the nominee shown resilience in the face of challenges, while still making exceptional achievements? Be specific about examples.
o Based on your evaluation of the nominee’s academic career to date, what is the likelihood of the nominee to finish the degree program to which they were admitted? Why?
Please do not include:
· GRE scores
· Departmental rankings
INTERVIEW CONFIRMATION
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):
FACULTY MENTOR / Please provide the name and contact information for the proposed faculty mentor for this diversity fellowship nominee:
Name:
Department:
E-mail:
Telephone extension:
ZOT Code:
REQUIRED SIGNATURE
Graduate Program Advisor / or Dept. Chair (type name) / Date
SUBMISSION INSTRUCTIONS / Complete the GOF Nomination Form for each student the department is nominating.
Complete the GOF Nomination Form for each student the department is nominating. Don’t forget the following items:
· Check the appropriate Citizenship or Residency box
· Check appropriate degree objective box
· Minimum $3,000 summer stipend in year 1
· Department contribution for years 1 - 5
· Mentoring plan for the student
· Rationale for nominating the student
· Save nomination form as “GOF-SID#.doc or .docm”
· Print nomination form and gather original signatures (no signatures on behalf of signee will be accepted) for each form
Scan all documents in PDF Format for students being nominated in the following order:
· Nomination Form (signed)
· Transcript
· Mentoring Plan
· Program Recommendation
· Copy of the student’s application from DAVAD.
· Statement of Purpose/Personal History Statement
· Letters of recommendation
Save this PDF file as “GOF–SID#.pdf
Schools submit completed documentation for the schools nominees to by Tuesday, February 20, 2018 and include the following:
· Original Word (.doc or .docm) Nomination Form for each student the school is nominating
· Scanned PDF nomination packet for each student the school is nominating
Revision Date: 12/2017