Internship Offices Network

McGill University

LeacockBuilding, Room 307

855 Sherbrooke Street West

Montreal, Quebec, Canada

H3A 2T7

PFF Community Leadership Program – Fellowship Application Form

Please read the instructions very carefully. Late or incomplete applications will not be accepted.

Please TYPE your answers.

Personal Information

Name:
(Last name) (First name)
McGill Student ID Number:______
Faculty and Year: ______
Program(s): ______
Expected Graduation Date: ______
Date of Birth: ____________
Country of Citizenship: ____________

Mailing Address and Contact Information

StreetAddress:______
City/Prov./Country: Postal Code:______
Telephone #: McGillEmailAddress:

Permanent Address (if different from mailing address)

Street:______
City/Prov./Country: Postal Code:______
Telephone #:______

Projects do not require affiliation with a sponsoring organization, but endorsement from a local organization or community leader is essential.

Project Name:______
Project Location: ______
Project Duration and Dates: ______
Project Summary (2 sentences maximum):______
______
______
Endorsing Partner’s Name (organization, business, group or individual): ______

Short Bio (150 words maximum)

Detailed Project Proposal

  1. Project Description

Please provide a detailed description of your project. What are the community needs you are addressing, as well as the needs and requirements of your community partner? What are your objectives and expected short and long-term results? How will the project bring positive social change to the community in which you plan to work? Why have you chosen this project? Describe how your project is innovative and/or entrepreneurial, if applicable. (1000 words maximum)

(Question 1 continued)

  1. Please provide a detailed timelinefor your project. The timeline should outline each stage (and activities) of your project and should specify the dates by which you intend to achieve your goals. It should also specify how you will ensure the project remains on schedule. (500 words maximum)
  1. Sustainability
    Is your project sustainable? How will the positive impact on the community successfully continue following your departure? Can the project expand once you leave? (250 words maximum)
  1. Project Environment

Describe the socio-economic, cultural and/or political environment of the community, region or country in which your project would be implemented. Provide a description of the potential impact your project will have on the community (e.g., on public health, the environment, social issues, gender-related issues, etc.). Describe how you will ensure the project does not have a negative impact on the community. (500 words maximum)

  1. Please describe your local community partner. What is the partner’s role in the community and why did you select them? Do you have prior links to or experience dealing with your partner? Is your partner capable of providing you with support and guidance during your project? In what other ways can your partner contribute to your project? (250 words maximum)
  1. Risks and Challenges
    Describe all potential risks and challenges in implementing your project. These could include operational or financial risks, risk to a sponsoring organization’s reputation, etc. Outline your strategy for averting or mitigating such risks. (250 words maximum)
  1. The Applicant

Outline any experience you have that is relevant to the proposed project, as well as any volunteer activities you have engaged in previously. (250 words maximum)

  1. Describe any courses/training/workshops you have taken or will take in advance of the project that will help you to succeed in project implementation. Be sure to clearly indicate which courses/training/workshops you will only take if you obtain this fellowship (250 words maximum).
  1. Please describe your qualifications to implement your project in your community of choice. Please evaluate your ability to integrate into the community based on existing links to it, as well as previous experience living, working or travelling overseas. Please indicate your languages capacities with regards to the community of your choice(250 words maximum)
  1. References

Please provide us with the names, titles, phone numbers and e-mail addresses of theindividuals providing you withyour reference letters, as well as thename, title, phone number, e-mail address and, if applicable, address of your sponsoring organization or local community partner.

Application Checklist

Cover page with name and title and abstract of the project (max. 100 words)
Application Form
Budget form
Letter of interest (max. 1 page)
Applicant CV
Official McGill transcript in sealed envelop
Two letters of recommendation sent directly by e-mail toAnne Turner
Letter of Support from a person of influence in the community or a decision maker of the local community partner
Expert evaluation form
I have read the PFF Community Leadership Program handbookand understand what my obligations will be prior to the start of the project, during the project and following completion of the project.
I understand and consent that my entire application (form and appendices) will be shared with the selection committee for the purposes of evaluation.
I understand and consent that, if selected, I will be required to submit monthly reports to the Internship Offices Network, and that my reports may be shared with the Pathy Family Foundation.
I understand and consent that Fellowship recipients will be invited to promote the Program at the University when feasible (e.g., presenting their experience at information events) and that materials submitted by recipients may be used on the Fellowship website. Fellowship recipients will be asked to share contact information and possibly communicate with the Pathy Family Foundation postselection.

For projects outside of Canada

I understand that I must attend a University-wide pre-departure session (April2014).

I will register my travel on the University travel registry.

I have read and will adhere to the University-Related International Travel Guidelines listed at:

DECLARATION

I hereby declare that the information contained in this application is accurate and true.
Signature: ______Date: ______

PLEASE SUBMIT APPLICATIONS ELECTRONICALLY TO:

ANNE TURNER AT

BY 12:00 PM (EST) February 3, 2014– No late or incomplete applications will be accepted.

All applicants will be notified of the final decision for their application.

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