UM Knight Wallace Fellows Application

Knight-Wallace Fellows
University of Michigan Academic Year September-April

Deadline for Applications: February 1 Postmark

U.S. Applicants: Submit three copies of all application materials.
International Applicants: Submit one copy of all application materials.
Information will be used only to evaluate applicants and will be kept
confidential.
Please type or print legibly and complete all items. Refer to website for further information.
Do not bold, staple or bind materials.

1.	Name	____________________________ Social Security #_____________________
2.	Title	________________________________________________________________
3.	Employer	________________________________Parent Company __________________
4.	Supervisor	____________________________ Telephone (______) ____________________
5.	Preferred Mailing Address Please circle: Office or Home
6.	Office Address	__________________________________________________________________
7.	Home Address	___________________________________________________________________
8.	Telephone:	Office (_____)___________________________ Home (_____)___________________________ Cell (_____)___________________________ Fax (_____)_____________________________
9.	Email	_______________________________________________________________________
10.	Please circle:	Female or Male
11.	Date of Birth	_______________________________________________________________________
12.	Place of Birth	_______________________________________________________________________
13.	Citizenship	_______________________________________________________________________
14.	Civil Rights Code (Optional) Please circle: Black/African American Hispanic/Latino American White/Caucasian Asian American American Indian Other______________________________
15.	Education:
	Undergraduate	_______________________________________________________________________
	Dates	_______________________________________________________________________
	Degree(s)	_______________________________________________________________________
	Graduate	_______________________________________________________________________
	Dates	_______________________________________________________________________
	Degree(s)	_______________________________________________________________________
16.	Foreign Language Proficiency __________________________________________________________________________
17.	Major Journalism Prizes and/or Awards and Year Awarded __________________________________________________________________________ __________________________________________________________________________
18.	Number of Years of Professional Journalism Experience ________________________________________________________________
19.	List on a separate sheet all positions held since completing formal education, beginning with current employment and following this order: · Employer · Dates · Title · Immediate Supervisor · Annual Salary
20.	Provide a typed intellectual autobiography of up to 1,500 words. Examine the intellectual and social values that shape your work as a journalist. Explore the origins of these values and explain how they contribute or relate to satisfaction derived from journalism.
21.	Provide a typed projected study plan of up to 500 words. In what academic areas do you proposed to work? How do these relate to your career objectives? How do you plan to carry out this work: courses? tutorials? research? Indicate areas of study, not specific classes. Summary statement of study plan: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
22.	Provide examples of your professional work. No entry materials will be returned. Do not use scrapbooks, presentation folders or staples U.S. Applicants: Provide three copies of each sample. International applicants: Provide one copy of each sample and English translations. Print journalists: Send up to five articles or photographs. At least three of these samples should be from the past two years. Clippings must be dated and legible. Mount entries or photocopies flat on 8-1/2 x by 11” paper or send the online version as a printout. Do not fold, bind or embellish entries. Editors or managers, who might find it hard to send writing samples, should include instead a typed statement of up to 500 words, describing their work and their approach to it. Broadcast journalists: Send DVDs or CDs with examples of work. Maximum viewing or listening time should be one-half hour and include work from the past two years. Also, include a brief typed description of the work on the disk, including date aired, and a statement of up to 500 words describing your work, including major programs for which you have been responsible. Online journalists: Submit samples equivalent to five print articles or 30 minutes of programming. Include a brief typed description of your involvement in each piece.
23.	Four letters of reference are required: Letters should be sent directly from the letter writer. They can be submitted by one of three methods: email, fax or mail. Writer should submit letter by only one method. Email should be addressed to kwfellows@umich.edu and reference the applicant in the subject heading. Email and faxes should arrive by February 1. Mailed letters should be mailed directly to us at the address below and postmarked no later than February 1. International applicants: All letters should be written in English or be accompanied by an English translation. 1. One professional letter of reference. List name and affiliation. _______________________________________________________________ 2. One personal letter of reference. List name and affiliation. _______________________________________________________________ 3. One confidential letter from your immediate supervisor (if applicable) elucidating your qualifications for a Knight-Wallace Fellowship. List name and title. _______________________________________________________________ _______________________________________________________________ 4. A letter from your employer supporting your application and granting you a leave for the academic year if you should be offered a fellowship. If you are unable to obtain this letter, please explain why in a typed statement and send an additional letter of reference. List name and title. _______________________________________________________________ _______________________________________________________________
Note for applicants with employer support: In accepting a fellowship you promise to return to your place of employment at its conclusion. Signature ____________________________________________________________________
How did you learn of the Knight-Wallace Fellowship? __ Web advertisement __ Email advertisement __ Internet Search __ Journalism Convention __ Knight Wallace Fellow __ Friend/employer __ Other: ________________________________________________ Send application to: Charles R. Eisendrath, Director Knight-Wallace Fellows Mike and Mary Wallace House 620 Oxford Road Ann Arbor, MI 48104-2635 734-998-7666 Fax: 734-998-7979 The University of Michigan, as an Equal Opportunity/Affirmative Action employer, complies with all applicable federal and state laws regarding non-discrimination and affirmative action, including Title IX of the Education Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973. The University of Michigan is committed to a policy of nondiscrimination and equal opportunity for all persons regardless of race, sex, color, religion, creed, national origin or ancestry, age, marital status, sexual orientation, disability or Vietnam-era veteran status in employment, educational programs and activities, and admissions. Inquiries or complaints may be addressed to the University's Director of Affirmative Action, Title IX and Section 504 Coordinator, 4005 Wolverine Tower, Ann Arbor, Michigan 48109-1281, 734-763-0235, TDD 734-747-1388, FAX 734-763-2891.