APPLICATION FOR SARAH H. MOSS FELLOWSHIP

Applications due April 6, 2009
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For academic year beginning August 1, 2009. Please include the following information.

I. PERSONAL INFORMATION

Name of Applicant

Present Title

Department

Date of First Faculty Connection with University (applicant should be a UGA faculty member for at least one year)

Athens Address

Date of Birth

Marital Status

II. ACADEMIC BACKGROUND *

Colleges or Universities Attended		Date of Attendance		Degree

Undergraduate Major

Minor

Graduate Major

Minor

Academic Honors or Prizes

Extracurricular activities in college

* A copy of a current vitae is desirable.

III. ADDITIONAL INFORMATION

Attach a brief description, not to exceed one page, of the plan of study you desire to pursue if awarded this fellowship. Indicate below your first and second choice of universities:

1.

2.

1. Attach separate statements showing:
2. Experience to date
3. Research and service achievements
4. Aims and purposes in pursuing the proposed program of graduate study
5. The amount of stipend which you will receive from the institution you expect to attend and from other sources
6. An itemized budget of the costs of attending the institution during the time period indicated

Also have submitted directly to the Center for Teaching and Learning letters of recommendation from three (3) persons qualified to report on your academic interests and capacities and statements from your academic dean and department head indicating that you may be given a leave of absence. In addition, the department head is asked to respond directly to the selection committee chair regarding the applicant's long-term promise as a faculty member at the University of Georgia.

It is understood that the recipients of Sarah H. Moss Fellowships are expected to return to the University. Recipients, accordingly, sign an agreement acknowledging that if they do not return they agree to refund the amount of Fellowship funds received in full.

Signature of Applicant

Date

Please return all application materials to:

Chair, Sarah Moss Selection Committee
Center for Teaching and Learning
Instructional Plaza

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This page last updated on June 12, 2009.