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Frederick Douglass Teaching Scholars
Summer 2009 Application
Application Deadline: Priority consideration given to completed applications postmarked by November 16, 2008
Name:
(Last) (First) (Middle)
Address__________________________________________________________________________________
(Street, Apartment or P.O. Box Number)
________________________________________________________
(City) (State) (Zip)
Phone (_____) __________________________ Phone (_____) ____________________________
(Office) (Home)
Email address______________________________________________________
Do you have active status in a terminal degree program? _____Yes _____No
If yes, please complete the following:
Program_______________________________________________________
(MA, PhD) (Department)
University_________________________________ City______________________________ State____________
Expected date of degree completion_____________________________________________________
(Month, Year)
Please indicate your current situation:
___ Taking course work in a doctoral/terminal program
___ Have completed required course work in a doctoral/terminal program, but have not passed oral exam
___ Have passed oral exams and working on doctoral dissertation
___ Other (please explain) ____________________________________________________________________
___________________________________________________________________________
Name of your major ________________________________ Adviser: __________________________________
Major adviser's mailing address: _________________________________________________________________
Major adviser's phone number: (_____) _________________________________
Do your future plans include teaching in higher education? _____Yes _____No
Do you have college or university teaching experience? _____Yes _____No
If yes, please describe: ____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
As a teaching scholar, what course(s) for undergraduate students are you most interested in and/or best prepared to teach?
Most Interested Best Prepared
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
Signature of Applicant: _____________________________________________________
How did you learn about this fellowship?
Advertisement (Source) _________________________________
Posting (Where Posted) _________________________________
Other (Please Specify) __________________________________
NOTE: This application must be accompanied by:
* A cover letter and curriculum vita describing your research area(s), experience and qualifications.
* A copy of your graduate transcript. (This can be a copy of the official transcript)
* A letter from your major or dissertation adviser regarding your qualifications for this program.
* A letter from at least two additional references regarding your experience and ability. (If you have teaching experience, letters should include relevant
information.)
Send this application and related materials to the University of your Choice. You are permitted to apply to more than one University but you must send separate copies of material to each University. Mailing addressed for each university are located at