WHETTEN GRADUATE CENTER | 438 WHITNEY ROAD EXTENSION, UNIT-1152, STORRS CT 06269-1152 TELEPHONE: (860) 486-3617 | FACSIMILE: (860) 486-6739 | GRAD.UCONN.EDU DOCTORAL DISSERTATION FELLOWSHIP COMPETITION - FALL 2015 SEMESTER FIRST NAME LAST NAME STUDENT ID # (SEVEN DIGITS) PHONE NETID EMAIL ADDRESS CITY STATE ZIP FIELD OF STUDY TITLE OF DISSERTATION ARE YOU A US CITIZEN OR RESIDENT ALIEN? YES NO Funding has been made available to support a limited number of Doctoral Dissertation Fellowships for the Fall 2015 Semester. The amount of the fellowship is $2,000. Fellowships will be awarded competitively, which will involve the rank ordering of eligible applicants by faculty in various program areas, if the number of eligible applicants exceeds the number of available fellowships. ELIGIBILITY. To be eligible for the fellowship, an applicant must (1) certify that his/her total personal income will not exceed $35,000 during the twelve-month period of July 1, 2015 to June 30, 2016; (2) must document satisfactory completion of the General Examination prior to 4:00 pm on April 30, 2015; (3) submit his/her Dissertation Proposal (ready for full approval and include full and current IRB or IACUC approval for the use of any human and/or animal subjects involved in the research or SCRO approval for the use of any human stem cell) to The Graduate School before 4:00 pm on April 30, 2015; and (4) must certify that he/she will not defend his/her dissertation prior to August 12, 2015. Doctoral students based at the Health Center in Farmington are not eligible to apply for this particular fellowship. This fellowship can be awarded to an individual only once. APPLICATION SUBMISSION. Submit one original to Kelly Jones, executive assistant, Graduate School, Unit 1152, Storrs, the UConn Graduate School (gradschool.uconn.edu), in person or via fax to (860) 486-6739. NOTIFICATION. IMPORTANT NOTE. counselor to see how this affects your aid before accepting this fellowship. PAGE 1 OF 2 INCOME CERTIFICATION. Please indicate below all anticipated personal income for the period July 1, 2015 to June 30, 2016. Include income from all sources (both inside and outside the University) and specify amounts. Do not include your spouse’s income. Please note that you are not eligible to receive this fellowship if your anticipated personal income for the twelve-month period exceeds $35,000. TIME PERIOD SOURCE AMOUNT TOTAL AMOUNT $ ELIGIBILITY CERTIFICATION AND SIGNATURES We certify the following: • The applicant’s anticipated personal income for the period above is less than $35,000 • The applicant has never before been awarded a University of Connecticut Doctoral Dissertation Fellowship • The applicant will have successfully completed the doctoral General Examination and the result will have been reported to the Graduate School by 4:00 PM on April 30, 2015 • The applicant will have submitted to the Graduate School by 4:00 PM on April 30, 2015 a fully approvable Dissertation Proposal (including all needed institutional approvals for the use of human and/or animal subjects or the use of human stem cells) • The applicant will not defend his or her dissertation before August 12, 2015 ADVISOR’S NAME (TYPED OR PRINTED) SIGNATURE MAJOR ADVISOR PROGRAM OR DEPARTMENT HEAD APPLICANT SIGNATURE DATE RECEIVED BY THE GRADUATE SCHOOL SIGNATURE DATE PAGE 2 OF 2