The Albert Schweitzer Fellowship

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Boston

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Chicago

Houston

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Los Angeles

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New Orleans

North Carolina

Pittsburgh

Please complete the following application for the 2010-2011 BSFP.

Paired Project Note: Applicants applying as a pair should complete individual applications. Answers to questions about the project and faculty mentors can be identical; all other answers should be individual.

(*Required fields)

*First name:

*Last name:

*Address:

Address 2:

*City:

*State:

*Zip:

*Phone:

*Email:

Partner Name (if applicable):

*School:

Other School:

*Discipline:

Other discipline:

*Will you be enrolled in a degree-granting program through April 2011?

Yes No

Selected Fellows are expected to participate in monthly Fellowship activities throughout the year (April 2010-April 2011). Please indicate any times you anticipate being out of the area and/or unable to participate in Fellowship activities:

*Describe in one sentence your motivation for applying to the Schweitzer Fellowship:

*Please describe your proposed community service project. Discuss project goals, objectives, time frame, and plans for evaluation and sustainability. Include any community agency or agencies you plan to collaborate with to implement your project. Describe how your proposed project meets a demonstrated need in the community and supports local and national health priorities.
(Word limit: 700 words)

*Please discuss what you hope to gain from being a Schweitzer Fellow and from participating in group Fellowship meetings and activities. What skills and experiences do you bring to the Fellowship, including previous experiences as a volunteer? What it might mean for you to belong to an alumni network of “Fellows for Life”?
(Word limit: 700 words)

*How did you learn about the program?

*Please list two or three faculty members at your school who could serve as a faculty mentor for the Schweitzer Fellowship:

*Please list the contact information for 1-3 References:

Additional comments:

*Resume:
Please paste your resume into the text box below and format it the best you can. Due to the volume of applications separate attachments cannot be accepted.