I. Applicant Information

 

Name:

U of M Student ID #
(if applicable)

Mailing Address:

Permanent Address:

Home Phone:

Cell Phone:

Work Phone:

E-mail:

Fax:

Citizenship (if not U.S., type of U.S. visa):

Please specify your relationship to the Upper Midwest region (e.g. place of birth, family home, location of school, location of work, former residence, etc.):

What human rights topics interest you? (e.g. women, children, health, education):

Current place of employment/student status:

Please explain how you learned about the Upper Midwest Human Rights Fellowship Program (e.g. email announcement, website, flyer, brochure, educator, past fellow, or other source):

II. Emergency Contact Information

Name:

Relation:

Home Phone:

Cell Phone:

Work Phone:

E-mail:

Fax:

III. Proposed Fellowship Information

(Not to exceed 2 pages)

A. Please provide a brief description of the proposed fellowship to be undertaken with this grant, including the proposed host organization and its location. (Maximum 100 words)

B. Language study relevant to area of fellowship. Include language, years of study, and practical experience.

C. Have you applied for any other financial assistance to pursue your proposed fellowship? If so, please describe.

D. Name, title, and address of supervisor in proposed host organization.

E. Dates of intended fellowship.

F. Itemized budget estimate for proposed fellowship.

IV. Attachments

A. 2-3 page essay describing:

- Fellowship placement
- Proposed host organization
- Significance of the experience for your academic or professional training
- Relationship of the fellowship to your future goals
- How the host organization will benefit from a fellowship
- Identify the key aspects of a current human rights issue in the country/location of your proposed fellowship and how the sponsoring organization addresses it
- Describe how you will use your new human rights experiences in your community upon your return home.

B. A résumé detailing your experience in the area of the proposed fellowship, including previous internships or fellowships, travel, education, employment, extracurricular activities, honors, etc. You may also wish to include a brief cover letter highlighting how these experiences will relate to your proposed fellowship.

C. A transcript of your most recent academic work (if less than ten years prior).

D. Written evidence of a commitment to the fellowship from the proposed host organization.

E. (Optional) A letter of reference regarding your relevant abilities and qualifications.

V. Deadline

Applications and supporting materials must be submitted by Friday, February 10, 2012 by 4:00 PM Central Time, to:

U of M Human Rights Center
Upper Midwest Human Rights Fellowship Program
Mondale Hall, Suite N120
229 19th Avenue South
Minneapolis, MN 55455

 

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