The Albert Schweitzer Fellowship

Please complete the following application for the 2010-2011 NH/VT SFP - Paired Projects. Each applicant (A and B) should separately fill out the contact information/school affiliation section and the individual section. The project information section should be completed jointly. For more information or if you have questions about your application, contact: Becky Torrey, Director Rebecca.b.Torrey@dartmouth.edu T: 603-643-1479 (*Required fields)
PARTNER A CONTACT INFORMATION AND SCHOOL AFFILIATION

*First name:
*Last name:
*Address:
Address 2:
*City:
*State:
*Zip:
*Phone:
*Email:

*School:


*Discipline:


*Expected year of graduation:


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

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:


PARTNER B CONTACT INFORMATION AND SCHOOL AFFILIATION

*First name:
*Last name:
*Address:
Address 2:
*City:
*State:
*Zip:
*Phone:
*Email:

*School:


*Discipline:


Expected year of graduation:


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

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:


PAIRED PROJECT INFORMATION

*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.


PARTNER A INDIVIDUAL SECTION

*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”?


*How did you learn about the program?


*Please list the contact information for 2-3 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.


PARTNER B INDIVIDUAL SECTION

*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”?


*How did you learn about the program?


*Please list the contact information for 2-3 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.