KILLAM FELLOWSHIPS

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					                         APPLICATION FOR A KILLAM FELLOWSHIP
                                 TO STUDY IN CANADA
                           FOR THE 2005-2006 ACADEMIC YEAR
                                 FOR AMERICAN UNDERGRADUATE STUDENTS

                      PLEASE READ ALL INSTRUCTION AND INFORMATION CAREFULLY
                               BEFORE COMPLETING THIS APPLICATION


Introduction to the Killam Fellowships Program

The Killam Fellowships Program provides exceptional undergraduate students from universities in Canada and the
United States with the opportunity to study in the neighboring country for either one semester or a full academic
year. Established in 2001 through a partnership between the Foundation for Educational Exchange between
Canada and the United States of America and the American Killam Trusts, the goal of the program is to increase
mutual understanding between Canada and the United States through academic exchange.


Award Provisions

Killam Fellowships provide a stipend of US$10,000 (US$5,000 per semester) and a health insurance allowance.
Additional funds are available for applicants from universities with high tuition costs. The fellowship also includes a
two-day orientation and additional funding for in-country educational travel on a competitive basis. Award
recipients are expected to use the fellowship to cover costs associated with their education. During the period of
their exchange, award recipients continue to pay tuition to their home institution, but do not pay tuition to their host
institution. Please note that all Killam Fellowships are subject to Revenue Canada and Internal Revenue Service
regulations.

Students in all majors and fields of study are welcome to apply.


Eligibility Requirements

In order to be considered for a Killam Fellowship to study in Canada, students must meet the following
requirements at the time of application:

   United States citizenship at the time of taking up the fellowship
   Status as a full-time undergraduate student in good standing at one of the participating US universities or
    colleges
   Fulfillment of the study abroad eligibility requirements and regulations of home university or college
   English-language fluency
   French-language proficiency if plan to study at Université de Montréal
   Superior academic achievement




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Application Process

Students must submit their application to the appropriate office at their home institution by the deadline set by their
home institution. Each participating university or college will select up to three nominees from the applicant pool to
forward to the Foundation for Educational Exchange between Canada and the United States of America for further
consideration. An independent selection committee will then review each application based on the applicant’s
academic record, personal statement, letters of reference, and overall fit to program objectives. Selections will be
announced by April.


Application Instructions

1. All forms in this application are to be completed in English and should be typed in font no smaller than 10 point.
2. Every question must be answered completely and carefully. Incomplete applications will not be considered.
3. Please limit your responses to the space provided and submit only the items requested; unsolicited materials
   will not be included in the review process.
4. Do not put material in a binder or folder. Use 8 ½“ x 11” white paper for all attachments to the application form.
5. Reference forms should be confidential, in sealed envelopes with the signature of the referee on the seal. At
   least one reference should be from a university or college professor.
6. Transcripts should be current, official and in sealed envelopes.

Complete application packages should be submitted to the appropriate office at your home university or college by
the deadline set by your home institution. Please see the list on the following page for information on whom to
contact about deadlines and where to submit your application.


Application Components

A complete application consists of the following components:

   complete application cover sheet
   complete, signed and dated application form
   personal statement (maximum 500 words)
   official, current university or college transcript in a sealed envelope
   photocopy of your birth certificate, passport or other documentation that verifies citizenship
   two confidential reference forms in sealed envelopes with the signature of the referee on the seal. At least one
    reference should be from a university or college professor
   French language proficiency form if you plan to study at the Université de Montréal


Selecting a Host Institution

Applicants are responsible for ensuring that their home institution approves the programs of study at their proposed
host institutions and that these programs meet all of their home institution’s academic requirements.

The Foundation for Educational Exchange will make every effort to place students at their highest ranked
university, but cannot guarantee students placement at their first choice school. Students are matched with
institutions according to the following guidelines: No single institution can host more than two Killam Fellows in a
given academic year; no more than two students from the same home institution can be awarded Killam
Fellowships in a given academic year.




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                  Please contact the office at your home institution listed below
                     to find out where and when to submit your application.
American University                                      Massachusetts Institute of Technology

   Paula Warrick                                            Annie McLeod
   Director, Merit Awards                                   Staff Associate, Office of Special Projects
   Career Center                                            Office of the Dean for Undergraduate Education
   Butler Pavilion - 5th Floor                              Room 6-205
   4400 Massachusetts Ave, NW                               Cambridge, MA 02139
   Washington, DC 20016-8011
                                                            Phone: 617-253-4378
   Phone: 202-885-1817                                      E-mail: atmcleod@mit.edu
   E-mail: warrick@american.edu


Bridgewater State College                                Plattsburgh State University of New York

   Robin Melavalin                                          David Mowry
   Associate Director                                       Director, Honors Program
   International and Exchange Programs                      Redcay Honors Center
   Graduate and Continuing Education                        Hawkins Hall, Rm. 121-123
   Clement C. Maxwell Library, Room 019                     Plattsburgh, NY 12901
   10 Shaw Road
   Bridgewater, MA 02325                                    Phone: 518-564-3075
                                                            E-mail: david.mowry@plattsburgh.edu
   Phone: 508-531-6183
   E-mail: rmelavalin@bridgew.edu


Ithaca College                                           Smith College

   Diana Dimitriova                                         Donald Andrew
   Associate Director for International Student             Coordinator for Fellowships and Grants
   Services, Office of International Programs               Office for International Study
   213 Muller Center                                        College Hall 24B
   Ithaca, NY 14850                                         Northampton, MA 01063

   Phone: 607-274-3306                                      Phone: 413-585-4913
   E-mail: ddimitrova@ithaca.edu                            E-mail: dandrew@email.smith.edu


Harvard University                                       Wellesley College

   Jane Edwards                                             Jennifer Thomas-Starck
   Director, Office of International Programs               Director of International Studies
   University Hall Ground Floor South                       Green Hall, 339B
   Cambridge, MA 02138                                      Wellesley, MA 02481

   Phone: 617-384-7521                                      Phone: 781-283-2320
   E-mail: jedwards@fas.harvard.edu                         E-mail: jthomass@wellesley.edu


                  If you have any questions, please contact The Killam Fellowships Program
       at the Foundation for Educational Exchange between Canada and the United States of America:

                                      Amelia Brown, Program Officer
                                       abrown@killamfellowships.com
                                              (613) 688-5511


                                                   iii
                         THE KILLAM FELLOWSHIPS PROGRAM
                                    APPLICATION COVER SHEET




NAME:
           Family Name                            First Name                                 Middle Initial



HOME INSTITUTION:


MAJOR(S):


CHECKLIST
Please check to see that you have included the following items in your application packet:

    This cover sheet

    Application form, completed, signed and dated

    Personal statement (maximum 500 words)

    Current official university or college transcript in a sealed envelope

    Photocopy of your birth certificate, passport or other documentation that verifies citizenship

    Two reference forms in sealed envelopes with the signature of the referees on the seals. At least one
     reference should be from a university or college professor.
    French language proficiency form if you plan to study at the Université de Montréal



For official use only. To be completed by home institution of applicant.

Name of Killam Campus Representative:_______________________________________________________

Title and Department:______________________________________________________________________

Signature:_________________________________________________               Date: _______________________

Committee decision (please check one):                                       Nominate         Do not nominate

                                                         1
                         THE KILLAM FELLOWSHIPS PROGRAM
            APPLICATION FOR A KILLAM FELLOWSHIP TO STUDY IN CANADA
                        FOR THE ACADEMIC YEAR 2005-2006
1. NAME OF APPLICANT:

      Mr.
      Ms.
               Family Name                         First Name                           Middle Initial


2. CONTACT INFORMATION:

   Current Address:




    City                        State                      ZIP Code                     Date Valid Until


    Current Phone Number:                                  Current E-mail Address:


   Permanent Address (if different from above):




    City                                  State                                  ZIP Code


    Phone Number:                                       E-mail Address:


    Emergency Contact Name:

    Relationship:

    Telephone Number(s):


3. DATE OF BIRTH:
                        Month                     Day                 Year


4. BIRTHPLACE:
                      City                         State               Country


                                                   2
5. ARE YOU A UNITED STATES CITIZEN?                          YES             NO


6. DO YOU NOW, OR HAVE YOU EVER HELD
                CANADIAN CITIZENSHIP?                                        YES             NO
                CANADIAN LANDED IMMIGRANT STATUS?                            YES             NO


7. EDUCATIONAL PROFILE:
   List post-secondary educational institutions attended in reverse chronological order, including any in which you
   may be presently enrolled.

                                                        DATES
                                                                                            Date Degree
                                                    (Month and Year)     Type of Degree
Institution and Location    Major(s) and Minor(s)                                           Received or        GPA
                                                                           (e.g. B.A.)
                                                    FROM        TO                           Expected




8. SCHOLARSHIPS OR FELLOWSHIPS HELD AT PRESENT OR IN THE PAST:

         Name                          Source                  Amount              Dates            Where Held




9. OTHER AWARDS, INTERNSHIPS, EXTRACURRICULAR ACTIVITIES, OR SPECIAL ACHIEVEMENTS:

                  Award/ Activity                                  Date(s)                 Place (if applicable)




                                                         3
 10. KNOWLEDGE OF LANGUAGES: (Please rate as Excellent, Good or Fair to indicate level of proficiency)

     FIRST LANGUAGE:

      LANGUAGE                          READING                      WRITING                    SPEAKING
      English
      French
      Spanish
      Other

     IMPORTANT NOTE: If you have selected the Université de Montréal as one of your possible host
     universities and your first language is not French, you are required to submit the Language Proficiency
     Form.


 11. VISITS ABROAD DURING THE PAST TEN YEARS, INCLUDING PREVIOUS EXPERIENCE IN CANADA:
     (Please include only those visits of one month or longer.)

                 Country/Area                                  Purpose                             Dates of Stay




 12. PLEASE INDICATE WHETHER YOU WOULD LIKE TO SPEND ONE SEMESTER OR THE FULL ACADEMIC
     YEAR IN CANADA:

                             ONE SEMESTER                              FULL ACADEMIC YEAR

     IF YOU SELECTED ONE SEMESTER, PLEASE INDICATE WHICH SEMESTER:

                                     FALL SEMESTER
                                     SPRING SEMESTER
                                     EITHER SEMESTER


 13. PREFERRED HOST INSTITUTIONS
     Please indicate your preferred host institutions by ranking the universities below in order of preference.

                      ACADIA UNIVERSITY                                   QUEEN’S UNIVERSITY

                      DALHOUSIE UNIVERSITY                                UNIVERSITÉ DE MONTRÉAL

                      MCGILL UNIVERSITY                                   UNIVERSITY OF OTTAWA

                      MCMASTER UNIVERSITY                                 UNIVERSITY OF TORONTO

                      MEMORIAL UNIVERSITY                                 YORK UNIVERSITY

                      MOUNT ALLISON UNIVERSITY

Applicants are responsible for ensuring that their home institution approves the programs of study at their proposed
host institutions and that these programs meet all of their home institution’s academic requirements.
                                                           4
14.     HOW DID YOU LEARN OF THE KILLAM FELLOWSHIPS PROGRAM?




15.     STATEMENT BY APPLICANT:

By my signature I certify that, to the best of my knowledge, the information provided in my application is
accurate and complete.

SIGNATURE:                                                              DATE:



16.      PERSONAL STATEMENT: Please attach a typed narrative statement of not more than 500 words
explaining why you want to study in Canada as a Killam Fellow. Please discuss what you hope to accomplish
during your semester or year in Canada and how the experience fits with your current interests and future goals.
Given that the Killam Fellowships Program seeks to further mutual understanding between Canada and the United
States, please also highlight any experiences that demonstrate your ability to adapt to other cultural settings, a
willingness to share with or learn from others of different national identities, and your ability to act in an
ambassadorial capacity for the United States.




                                                          5
                           THE KILLAM FELLOWSHIPS PROGRAM
                                           REFERENCE FORM 1

Instructions for Referee: Please complete this two-page confidential reference form to the best of your
knowledge. You can include additional comments in a letter if you wish. Please place the complete form and letter
(if including) in an envelope, seal the envelope and sign over the seal of the envelope. Please return the sealed
envelope to the student, who will submit it along with his/her application form.


1. NAME OF APPLICANT:

        Mr.
        Ms.
                Family Name                         First Name                               Middle Initial


2. NAME OF REFEREE:

        Dr.
        Mr.
        Ms.
                Family Name                         First Name                               Middle Initial



3. REFEREE CONTACT INFORMATION:

     Address:




      City                                 State                                 ZIP Code


      Phone Number:                                          E-mail Address:



4.      JOB TITLE AND EMPLOYER:



5.       RELATIONSHIP TO APPLICANT:



6.      HOW LONG HAVE YOU KNOWN THE APPLICANT?



                                                         1
7. PLEASE EVALUATE THE APPLICANT IN COMPARISON WITH OTHER STUDENTS WHOM YOU HAVE
  KNOWN DURING YOUR PROFESSIONAL CAREER:

                                           Excellent          Very Good         Average   Below Average

     Academic Performance

     Intellectual Ability

     Resourcefulness and Initiative

     Work Habits

     Maturity

     Leadership Qualities

     Ability to Adapt to New
     Situations


     Comparison Group:                Total Number of Students over           Years.




8.   ADDITIONAL COMMENTS:




9. PLEASE SIGN AND DATE BELOW:



SIGNATURE:                                                            DATE:




                                                          2
                           THE KILLAM FELLOWSHIPS PROGRAM
                                           REFERENCE FORM 2

Instructions for Referee: Please complete this two-page confidential reference form to the best of your
knowledge. You can include additional comments in a letter if you wish. Please place the complete form and letter
(if including) in an envelope, seal the envelope and sign over the seal of the envelope. Please return the sealed
envelope to the student, who will submit it along with his/her application form.


1. NAME OF APPLICANT:

        Mr.
        Ms.
                Family Name                         First Name                               Middle Initial


2. NAME OF REFEREE:

        Dr.
        Mr.
        Ms.
                Family Name                         First Name                               Middle Initial



3. REFEREE CONTACT INFORMATION:

     Address:




      City                                 State                                 ZIP Code


      Phone Number:                                          E-mail Address:



4.      JOB TITLE AND EMPLOYER:



5.       RELATIONSHIP TO APPLICANT:



6.      HOW LONG HAVE YOU KNOWN THE APPLICANT?


                                                         1
7. PLEASE EVALUATE THE APPLICANT IN COMPARISON WITH OTHER STUDENTS WHOM YOU HAVE
  KNOWN DURING YOUR PROFESSIONAL CAREER:

                                           Excellent          Very Good         Average   Below Average

     Academic Performance

     Intellectual Ability

     Resourcefulness and Initiative

     Work Habits

     Maturity

     Leadership Qualities

     Ability to Adapt to New
     Situations


     Comparison Group:                Total Number of Students over           Years.




8.   ADDITIONAL COMMENTS:




9. PLEASE SIGN AND DATE BELOW:



SIGNATURE:                                                            DATE:



                                                          2
                         THE KILLAM FELLOWSHIPS PROGRAM
                         FRENCH LANGUAGE PROFICIENCY REPORT
                        TO STUDY AT THE UNIVERSITÉ DE MONTRÉAL

 Candidates who have selected the Université de Montéal as one of their possible host institutions are required
 to submit this French Language Proficiency Report along with their application for a Killam Fellowship. This
 confidential report is meant to provide an indication of the applicant’s present command of French, including
 any need for additional language training. This form must be completed by a professor of French.

 Instructions for Evaluator: Please complete this two-page confidential language report to the best of your
 knowledge. Please place the completed form in an envelope, seal the envelope and sign over the seal of the
 envelope. Please then return the sealed envelope to the student, who will submit it along with his/her
 application form.

1. NAME OF APPLICANT:

        Mr.
        Ms.
                Family Name                              First Name                          Middle Initial


2. NAME OF EVALUATOR:

        Dr.
        Mr.
        Ms.
                Family Name                         First Name                               Middle Initial



3. EVALUATOR CONTACT INFORMATION:

     Address:




      City                                State                                ZIP Code


      Phone Number:                                          E-mail Address:



4.      RELATIONSHIP TO APPLICANT:




                                                         1
5. EVALUATION METHOD AND SCORE:

   Please indicate briefly how the evaluation was conducted. Mention which test was used and the score results.

    Method Used:



    Test Score:


6. ABILITY:


  Is the applicant’s mother tongue French?          ☐    Yes        No

  Please mark the appropriate boxes below to indicate your assessment of the applicant’s present ability in French.
  Please use as a benchmark the level of proficiency required for full-time study in French at the university level.

  (a) Speaks French                                              (b) Understands Spoken French

        Fluently and colloquially                                        With good comprehension
        With ease but with occasional errors                             With some hesitation
        Haltingly with frequent errors                                   Simple vocabulary only
        No ability                                                       Not at all

  (c) Understands Written French                                 (d) Expresses Thoughts in Written French
     Text Used: _      _____________________________
        Comprehends advanced level material                              With fluency and facility
        Comprehends intermediate level material                          With ease but ungrammatically
        Comprehends elementary level material                            On an elementary level only
        No ability                                                       No ability




7. ADDITIONAL TRAINING:

   In your opinion, how much additional French language training does this student require to undertake full time
   academic study in French at the university level?

       None                   Number of Weeks:                           Number of Months:




8. PLEASE SIGN AND DATE BELOW:


SIGNATURE:                                                               DATE:




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