Application Date Enter Here
Sustainability Fellowship Program
ProjectHostApplication
2016-2017
Application Date[Enter Here]
Department/Organization [Enter Here]
Mailing Address[Enter Here]
Website[Enter Here]
Name of Primary Supervisor[Enter Here]
Title [Enter Here]
Email Address[Enter Here]
Phone Number[Enter Here]
If applicable:
Name of Secondary Contact[Enter Here]
Title[Enter Here]
Email Address[Enter Here]
Phone Number[Enter Here]
Have you been awarded an SSI grant before? YesNo
If yes, Grant Title, Award Amount & Date
Sustainability Fellowship Position Title[Enter Here]
Work Hours (10-15 per week)[Enter Here]
Position Summary
Briefly describe the position and your department or organization. This statement will be used for recruitment purposes.
Statement of Needand Sustainability Outcomes
Summarize theneed for the position, including the sustainability outcomes it will achieve for OSU or the Corvallis community. Please be sure to address the project’s impact on each of the three pillars ofsustainability (environmental, social, and economic), as appropriate.How will you monitor and evaluate progress towards these objectives? Indicate how the work meetsa unique need not already being completed in your department/organization.If you have received an SSI Wage Grant in the past, please highlight how the position responsibilities and sustainability outcomes differ from previous years’ positions. (Limit one page)
Learning Outcomes
What are the expected Learning Outcomes for the Fellow in the position and how will the Fellow achieve these outcomes? Please list the leadership competencies, transferable professional skills, andscholarly experiences the Fellow will gain through supervision, mentorship, networking, and professional development.Speak specifically to the knowledge and skills you hope to impart through this position in the areas of:
- Holistic Systems Thinking
- Sustainability Knowledge Awareness & Integration Skills
- Social Justice
- Sense of Place
- Change Agent Skills
- Practical Competence
(See Sustainability Learning Competencies)
Supervisor Qualifications
Please briefly explain your mentoring philosophy and your qualifications to serve as a supervisorand mentor to a student Sustainability Fellow in this position. (Limit one page)
Required Attachments:
Form A: Position Description
Form B: Sustainability Fellowship Work Plan Draft. If awarded, the Work Plan should be finalized with the student and submitted to SSI by Sept. 30, 2016.
By signing below, I agree that the above information is complete and accurate to the best of my knowledge. I will serve as supervisor for this position should fundsbeawarded by SSI.
Supervisor Signature: Date:
Transformative Learning* Intentional Engagement * Conscious Community *
Authentic Leadership * Social Justice
Page | 1