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					                                                                   Summer Institute on Climate Change
                                                                      FELLOWSHIP APPLICATION 2011

                                                FELLOWSHIP APPLICATION DEADLINE: APRIL 01, 2011

       Summer Institute Fellowship selection is based on the information you provide to the questions
       below. The deadline for applications is 3:00pm on April 01, 2010. Selection notifications will be
       announced no later than April 15, 2010. Unless otherwise noted, the fellowship will cover the
       expenses of housing, travel and transportation, all meals, team building activities, and all other
       costs of the program.

       Applications must be completed, signed, scanned and submitted electronically by emailing
       Summer Institute Director, Jenny Dissen ( Please include in subject line
       ‘Fellowship Application 2011.”

       Last Name:                                                                      First:

       Employer / Academic Institution:

       Title / Position:


       Phone:                                                                 Email:

       Signature of applicant:                                                                               Date:

       In the spaces below, please provide your comments that will assist the Summer Institute Committee in
       making a decision for you to receive a fellowship. Please use this form and write your responses
       directly in the form.

       Institution Affiliation:
       (list all colleges, universities, research institutions, etc. where you have attended, participated, taught,
       etc. List most recent/current first). For professionals, please list all professional societies, organizations
       where you have been involved, including extra-curricular activities.

       Statement of Interest and Applicant’s Learning Goals
       Please describe your interest in, and learning goals for, attending the Summer Institute. Please be
       specific about why this Program is of greatest interest to you, and what you hope to achieve from it.
       (Limit 300 words)

       Statement of Need
       Please tell us succinctly your reasons for applying for a Fellowship. Describe your current
       employment or research background and interests. Describe to the Summer Institute Committee
       why you should be a recipient of the Fellowship. (Limit 500 words)

Thank you for providing this information. Please email your responses to Jenny Dissen, Director of Summer Institute at 828 257 3135.