VISITING FELLOWSHIP APPLICATION FORM
The Maxwell School of Syracuse University
Program on the Analysis and Resolution of Conflicts
PERSONAL DATA
Last Name First Name Middle Initial
Address to which correspondence should be sent: Telephone Numbers:
Home: _______________________________
Office: _______________________________
Fax: ______________________________
Citizenship: E-Mail: _________________________
Date and country of birth: Sex: ________
Professional title and institutional affiliation:
________________________________________________________________________________________________
Preferred Term: Fall Semester Spring Semester Academic Year _______
Scholarly Discipline (i.e. political science, history, etc.): __________________________________________________
Title of project:
________________________________________________________________________________________________
REFERENCES
Please ask the people whom you list below to send their recommendations directly to PARC by March 19.
1)
NAME, TITLE and INSTITUTIONAL AFFILIATION
2) ________________________________________________________________________________________________
NAME, TITLE and INSTITUTIONAL AFFILIATION
EDUCATIONAL BACKGROUND
DATE • INSTITUTION • MAJOR FIELD
B.A./B.S. _____________________________________________________________________________________________
M.A./M.S. ____________________________________________________________________________________________
Ph.D. ________________________________________________________________________________________________
Other ________________________________________________________________________________________________
PROJECT INFORMATION
100-word summary of attached project proposal and its significance:
LANGUAGE
If English is not your native language, indicate your degree of fluency in English, using Excellent, Good, Fair, or Poor:
____________________________________________________________________________________
READING SPEAKING WRITING
In what language(s) relevant to your proposal are you proficient?
____________________________________________________________________________________
What language would you use in writing the final product proposed in this application?
_____________________________________________________________________________________
SIGNATURE
I certify that the information I have provided on this application form and in any attached materials is true and complete.
________________________________________________________________________________________________
FULL LEGAL SIGNATURE DATE
Return this application form along with your project proposal to:
Visiting Fellowship Applications, Attn: Mrs. Carin D. McAbee
Program on the Analysis and Resolution of Conflicts
The Maxwell School of Syracuse University
400 Eggers Hall
Syracuse, NY 13244-1090
USA