Frederick Douglass Teaching Scholars

Summer 2008

APPLICATION

Clarion University of Pennsylvania

______________________________________________________________

Name

__________________________________________________________________

Address (Street)

__________________________________________________________________

(City) (State) (Zip Code)

Phone (____)_____________ (Work) Phone (____)_____________ (Home)

Fax (___)________________

E-mail Address _____________________________________________________

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What is your active degree status? ABD __ Ph.D. ___

Program___________________________________________________________

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 (indicate status) _____________________________________________________

Name of your major advisor: __________________________________________

Major advisor’s mailing address: _______________________________________

__________________________________________________________________

Major advisor’s phone number: (___)____________________

fax: (___)____________________

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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: ___________________________________________________________

______________________________________________________________________________

__________________________________

Signature of Applicant

Optional Response: How did you learn about this fellowship?

Advertisement (Source): ______________________________

Posting (Where Posted): ______________________________

Other (Please Specify): ______________________________

NOTE: This application must be accompanied by:

¨ A full curriculum vitae with a letter of interest

¨ A copy of your graduate transcript. (This can be a copy of the official transcript).

¨ A letter from your major or dissertation advisor regarding your qualifications for this program.

¨ A letter from at least two additional references regarding your experience and ability. (If you had teaching experience, this letter should include information relative to that experience.)

SEND THIS APPLICATION AND RELATED MATERIALS TO:

The Frederick Douglass Teaching Scholars

Clarion University

Office of Social Equity, 207 Carrier Hall

Clarion, PA 16214

APPLICATION AND RELATED MATERIALS SHOULD BE POSTMARKED BY: February 4, 2008

CANDIDATES ARE USUALLY NOTIFIED OF THE UNIVERSITY’S DECISION IN EARLY APRIL

Questions: Please call: (814) 393-2109

An Affirmative Action/Equal Opportunity Employer