The Harvey E. Beech Professional Development Fellowship Application

Please review the entire form before you begin to make sure you have all the necessary information ready. Your application essay must be completed as a separate file (text or Microsoft Word) and submitted with this form. Please read the application essay instructions and complete the essay before starting the rest of the form.

All fields in this form are required unless otherwise noted

Personal Information

Please indicate the fellowship for which you are applying:

Last Name:
First Name:
Middle Initial (optional):

Personal Identification Number (PID):
Social Security Number (SSN):

Birth Date:

Are you a U.S. Citizen?

Yes No

Contact Information

Local Phone Number:

Local Address:

Street:
City:
State:
ZIP:

Permanent Phone Number if different from local:

Permanent Address if different from local:

Street:
City:
State:
ZIP:

Email Address:

Preferred Method of Contact:

Email Letter

Current Academic Information

Year in school (Fr., Soph., etc.):

Are you a full time student?

Yes No

Expected Graduation Date:

Name of Departmental Advisor:

College or School:
Major:
Second major if any:
Cumulative Grade Point Average:

References

Reference letters from two (2) persons need to be provided for your application. At least one must be a faculty member at UNC-Chapel Hill who can comment on your overall ability to successfully complete a fellowship program. These reference letters should be signed by the referee, sealed in an envelope, and delivered to The Stone Center soon after submitting this application.

Faculty Reference:

Name:
Title:
Academic Department:

Second Reference:

Name:
Title:
Department or Organization:

Employment

List any employment where your activities and experiences illustrate leadership roles, are relevant to your academic and career goals, or reflect aspects of the Fellowship for which you are applying.

Employer	Dates of Employment	Position & Responsibilities

Application Letter

Please attach a letter, no more than two (2) typed, double-spaced pages describing your academic and non-academic achievements and honors and provide insight as to why you were chosen for such recognition. Include in your letter a discussion of the leadership roles and extracurricular activities in which you are involved and how those experiences may have contributed to your interest in the Fellowship for which you are applying. The letter should also identify your academic, experiential and career goals, and discuss how the Fellowship experience will contribute to achieving them. Also, identify any valuable skills that you would bring as a Stone Center Fellow.

Attach your essay file (plain text, PDF, or Word Document format):

Honor Pledge

By checking this box, the applicant hereby agrees to conform to the codes of conduct, both within and outside of the classroom environment, as stipulated in The University of North Carolina at Chapel Hill Honor Code, and as detailed in the Instrument of Student Judicial Governance. Additionally, the applicant hereby attest that all information provided is true and accurate to the best of the applicant's ability.

After submitting this form, please remember to submit your other application materials to the Stone Center promptly. Review the application checklist and make sure that all parts of the application are completed.

Sonja Haynes Stone Center

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