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James B. Reynolds Scholarship Application
Student info
First Name
*
:
Middle Initial:
Last name
*
:
Dartmouth ID
*
:
Class
*
:
Email (FULL email address please, no nicknames)
*
:
HB
*
:
Current address
*
:
Permanent home address
*
:
GPA
*
:
Major
*
:
Minor:
Gender (optional):
Select an Option
Male
Female
No Response
Race/ethnic group (optional):
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Hispanic or Latino
Black/African American
Asian
White
Are you a US citizen
*
:
Select an Option
Yes
No
If not, what is your US residency status:
Select an Option
Permanent Resident
Non Resident
If not, what is your country of citizenship:
Honors/awards
*
:
Extracurricular activities:
Long-term career goals:
Faculty Recommenders (LIST TWO)
Recommender 1
Name
*
:
Email Address
*
:
Department/Affiliation
*
:
Recommender 2
Name
*
:
Email Address
*
:
Department/Affiliation
*
:
Project Information and Budget
Project Title or Degree Program
*
:
Project Abstract (max. 100 words): A brief summary of your proposal suitable for release if you are awarded funding
*
:
Program/Project Start Date
*
:
Program/Project End Date
*
:
Graduate Institution or Affiliation (First Choice)
Institution/Organization Name
*
:
Country
*
:
Accepted/Confirmed? (Please provide documentation)
*
:
Select an Option
Yes
No
Not Yet
Graduate Institution or Affiliation (Second Choice - optional)
Institution/Organization Name:
Country:
Accepted/Confirmed? (Please provide documentation):
Select an Option
Yes
No
Not Yet
Budget
Estimate your expenses and resources for your graduate study or independent work.
Expenses: First Choice Program
Tution and Fees:
Room and Board:
Travel:
Other Expenses:
Amount
Amount for Tuition and Fees:
Amount Room and Board:
Amount for Travel:
Amount for Other Expenses:
Description
Description of Tuition and Fees:
Description for Room and Board:
Description of Travel:
Description for Other Expenses:
Total Expenses
*
:
Expenses: Second Choice Program
Tution and Fees:
Room and Board:
Travel:
Other Expenses:
Amount
Amount for Tuition and Fees:
Amount Room and Board:
Amount for Travel:
Amount for Other Expenses:
Description
Description of Tuition and Fees:
Description for Room and Board:
Description of Travel:
Description for Other Expenses:
Total Expenses:
Resources Available to You (not including loans)
Resource 1:
Resource 2:
Amount
Amount for Resource 1:
Amount for Resource 2:
Description
Description for Resource 1:
Description for Resource 2:
Total:
Cost to You (Expenses minus resources)
First choice program
*
:
Second choice program:
If your total cost exceeds the amount of the Fellowship, please indicate how you expect to meet the difference:
Total amount of undergraduate loans:
Please provide any additional information that might be relevant to your application:
Proposal:
Please email your proposal as .doc, .docx, or .pdf to
Scholarship.Advising@Dartmouth.edu
. Please title your file with your last name and scholarship name, and include your last name and page numbers on each page. Please consult the website (
http://www.dartmouth.edu/~scholarship/scholarlist/graduate.html
) for more information.
Last Updated: 2/27/13
