ARCHIVAL EDUCATION AND RESEARCH
DOCTORAL FELLOWSHIP APPLICATION FORM
(Deadline Date: January 4, 2010)
Please provide the following information saved in pdf format. You may use extra space if necessary.
Name:
______
(Last) (First) (Middle)
Current Mailing Address: ______
(Street) (City) (State) (Zip)
Local Phone: ______E-Mail: ______
Gender (Optional): ______
Racial/Ethnic Background (Optional):
_____ African American/Black
_____ American Indian/Alaska Native
_____ Asian
_____ Caucasian
_____ Hispanic/Latino
_____ Native Hawaiian/Pacific Islander
_____ I prefer not to answer
Are you a United States citizen? ___ yes ___no
If not, are you a permanent resident? ______
(Applicants must be citizens or permanent residents of the US to be eligible.)
College(s)/University(ies) attended, dates, grade point average (please indicate graduating or current), major, and degree earned:
College/University 1: ______
Location: ______
(City) (State/Province)
Major: ______
Degree Received: ______Year of Graduation: ______GPA: ______
College/University 2: ______
Location: ______
(City) (State/Province)
Major: ______
Degree Received: ______Year of Graduation: ______GPA: ______
College/University 3: ______
Location: ______
(City) (State/Province)
Major: ______
Degree Received: ______Year of Graduation: ______GPA: ______
Employment Information
Employer 1: ______
Title of Position Held: ______
Description of Duties: ______
Dates of Employment: From ______To ______
Employer 2: ______
Title of Position Held: ______
Description of Duties: ______
Dates of Employment: From ______To ______
Employer 3: ______
Title of Position Held: ______
Description of Duties: ______
Dates of Employment: From ______To ______
Employer 4: ______
Title of Position Held: ______
Description of Duties: ______
Dates of Employment: From ______To ______
Archival Education and Research Doctoral Fellowship Participating Programs to Which You Have Applied or Plan to Apply* (Please mark an X for all those to which you have applied or plan to apply; you may apply to as many as you choose):
___ University of California, Los Angeles
___University of Michigan
___ University of Pittsburgh
___ University of North Carolina, Chapel Hill
___ Simmons College
___ University of Maryland
___ University of Texas, Austin
___ University of Wisconsin, Madison
*You are advised to inform programs of interest of your application for an Archival Education and Research Doctoral Fellowship program. You must complete the application process for programs in compliance with their deadlines.
Please describe your membership in societies and professional organizations along with any offices held:
______
______
______
Describe your leadership, community, civic, and volunteer experiences:
______
______
List any awards, scholarships, prizes, or honors received:
______
______
______
Provide information on individuals who have written, or will write, letters of reference (Your three references must include at least one past academic instructor):
Reference 1: ______
Title of Position Held: ______
Name, City, and State of Institution: ______
Phone Number: ______Email: ______
Reference 2: ______
Title of Position Held: ______
Name, City, and State of Institution: ______
Phone Number: ______Email: ______
Reference 3: ______
Title of Position Held: ______
Name, City, and State of Institution: ______
Phone Number: ______Email: ______
A complete application includes the following:
- Cover Letter
- Online Application Form
- Curriculum Vita
- Personal Statement
- Writing Sample
- Official Transcripts from all Educational Institutions
- Three Letters of Recommendation (at least one from an academic instructor/faculty). References should be instructed to enclose letters of recommendation in sealed envelopes with their signature across the seal and to return the letter to the applicant well before the deadline. Applicants are encouraged to notify their references immediately in order to allow ample time to receive letters and include them in the single packet of supporting documents.
Please send items 1-5 electronically in pdf format to the following email address: . All other materials must be postmarked by January 4, 2010 and mailed to the following address:
UCLACenter for Information as Evidence
UCLA Department of Information Studies
208A GSEISBuilding, Box 951520
Los Angeles, CA90095-1520
Applicants are urged to contact individual participating doctoral programs ahead of time stating their interest in the Archival Education and Research Doctoral Fellowship program, and to request information regarding the application process for their respective program and other requirements prior to applying.
Important: All Fellowship application packets and parts thereof must be received on or before January 4, 2010.
A Reminder:You must apply to at least one of the doctoral programs of the participating universities. All application materials corresponding to those applications – including possible duplicate materials such as transcripts and letters of recommendation – are to be sent separately from the Fellowship application and delivered on time to the respective school’s (or schools’) deadline.
Certification:
All information on this form is correct and complete to the best of my knowledge. I understand that to be eligible for this Fellowship I must apply to and be accepted in at least one of the eight graduate Archival Science Ph.D. programs specified. I also understand that receipt of funding is contingent upon continual full-time enrollment and institutional requirements.
Signature ______Date ______
Archival Education and Research
Doctoral Fellowship Personal Statement
In a personal statement of no more than 1,000 words, please address the following points (You may use extra space if necessary):
1)Why you want to earn a Ph.D. with an Archival Science focus.
2)Describe your research experience and the projected research area(s) you would like to pursue in the doctoral program.
3)Your commitment to, and potential for, an academic career in Archival Education.