laverne_noyes_app by wuzhengqin

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									Submit materials to:
Graduate Division
120 Aldrich Hall
Zot Code 3180                                                                              LAVERNE NOYES FELLOWSHIP
sbertram@uci.edu                                                                                    For Graduate Students
(949) 824-0373                                                                                              AY 2011-2012
STUDENT                          To avoid delays in application processing, students must complete all sections of this form and submit an application
                                 package with all required documentation to the Graduate Division by the nomination deadline. (Required information,
INFORMATION                      documents, and application deadlines can be found at http://www.grad.uci.edu/finance/noyes/index.htm)
Student Name (Last, First Middle):
                             Address:
                  City, State and ZIP:                                                                  Student ID #:
              Student e-mail address:                                                                Student Phone: (            )       -
                  Academic Program:                                                              Degree Objective:
Date of advancement to candidacy:                 /     /          Expected date of degree completion:         Fall     Winter        Spring
                                                                                                                                                     Year


                                    To avoid delays in application processing, please complete all sections of this form and submit the application
AWARD                               package with all required documentation to the Graduate Division by the application deadline. Required
RECOMMENDATION                      documents & application deadlines can be found at http://www.grad.uci.edu/finance/noyes/index.htm
All financial commitments are contingent on the student’s maintaining appropriate levels of academic performance and degree progress. Please refer
to specific program procedures and deadlines at: http://www.grad.uci.edu/finance/noyes/index.htm This section is to be completed by the academic
unit.

                                                                  UCI Graduate Division Commitment
    YEAR                           QUARTER                             (for one academic quarter)
                                                                                                                        Total Student Award

  2011- 2012               Fall         Winter        Spring      $ _______Stipend and/or $_______Fees                               $6,000


                                               To avoid delays, please complete all sections of this form. (Required documents and application
REQUIRED SIGNATURES                            deadlines can be found at http://www.grad.uci.edu/finance/noyes/index.htm)



   Student (Print Name)                                                 Signature                                                      Date



   Associate Dean (Print Name)                                          Signature                                                      Date



GRAD DIVISION USE ONLY
     Awarded                          Not Awarded                  Authorized Grad Division Signature:
                                                                                                                                              Date
Total Award Amount:                                                Graduate Division Actions:
Award Type:                                                                  Date dept. notified:
Quarter of Award:                                                            Fund source:
Stipend Amount:                                                              Date application input:
Fees Amount:                                                                 Date award input:
Tuition Amount:                                                              Date letter sent to student:
Other:

								
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