Please complete the following application for the 2010-2011 NCSFP - Paired Projects.
Each applicant (A and B) should fill out an individual section separately. The project information section should be completed jointly.
Please note the word limits in the text fields when answering the questions.
(*Required fields)
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| PARTNER A CONTACT INFORMATION AND SCHOOL AFFILIATION |
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| *First name: |
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| *Last name: |
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| *Address: |
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| Address 2: |
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| *City: |
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| *State: |
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| *Zip: |
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| *Home phone: |
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| Cell phone: |
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| *Email: |
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| *Will you be enrolled in a degree-granting program through April 2011? |
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| *School: |
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| Other School: |
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| *Discipline: |
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| Other discipline: |
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| PARTNER B CONTACT INFORMATION AND SCHOOL AFFILIATION |
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| *First name: |
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| *Last name: |
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| *Address: |
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| Address 2: |
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| *City: |
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| *State: |
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| *Zip: |
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| *Home phone: |
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| Cell phone: |
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| *Email: |
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| *Will you be enrolled in a degree-granting program through April 2011? |
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| *School: |
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| Other School: |
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| *Discipline: |
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| Other discipline: |
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| PAIRED PROJECT INFORMATION |
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| *Who is your target population (include demographic information): |
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| *Name of partnering community agency: |
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| *Describe your proposed community service project. Describe how your proposed project meets a demonstrated need in the community and supports local and national health priorities. What are your project goals and what actions will you take to meet those goals? How will you determine if you have met your goals at the end of the Fellowship year? (Word limit: 700 words) |
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| *What is the time frame for your project? (Please indicate a detailed month by month schedule with a specific start and stop time. Keep in mind, hours need to be complete by April 1, 2011): |
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*What are your plans for sustaining the project after your Fellowship year is complete? (Word limit: 300 words) |
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*Please list one or two faculty members at your school who could serve as your faculty mentor for your Schweitzer Fellowship: |
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*Please list someone at your proposed site who could serve as a site mentor: |
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| Optional: A letter of recommendation from your proposed academic mentor and a letter of endorsement from your site mentor are encouraged. You may also send letters of recommendation from people other than your mentors. Letters need to be received by February 1, 2010 and may be mailed to Barbara Heffner, Program Director, NC Albert Schweitzer Fellowship, PO Box 1636, Davidson, NC 28036. |
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| Additional comments: |
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| PARTNER A INDIVIDUAL SECTION |
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| *In one sentence, describe your motivation for applying to the Schweitzer Fellowship: |
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| *Please discuss what you hope to gain from being a Schweitzer Fellow and from participating in group Fellowship activities. What skills and experiences do you bring to the Fellowship? (Word limit: 500 words): |
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*Considering there are so many different types of community service projects Fellows can design, what inspired you to develop your particular project idea? (Word limit: 200 words): |
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*If you think you may stay in North Carolina after your training, please describe ways in which serving as a Schweitzer Fellow would deepen your commitment to, and skills in, long-term service to local underserved individuals or communities in the state (simply indicate Not Applicable if you are likely to practice outside of NC (Word limit: 200 words): |
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| *How did you learn about the program? |
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| *Resume (please do not be concerned about formatting; we are looking at content only): |
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| PARTNER B INDIVIDUAL SECTION |
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| *In one sentence, describe your motivation for applying to the Schweitzer Fellowship: |
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| *Please discuss what you hope to gain from being a Schweitzer Fellow and from participating in group Fellowship activities. What skills and experiences do you bring to the Fellowship? (Word limit: 500 words): |
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*Considering there are so many different types of community service projects Fellows can design, what inspired you to develop your particular project idea? (Word limit: 200 words): |
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*If you think you may stay in North Carolina after your training, please describe ways in which serving as a Schweitzer Fellow would deepen your commitment to, and skills in, long-term service to local underserved individuals or communities in the state (simply indicate Not Applicable if you are likely to practice outside of NC (Word limit: 200 words): |
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| *How did you learn about the program? |
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| *Resume (please do not be concerned about formatting; we are looking at content only): |
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