UM Knight Wallace Fellows Application

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

Deadline for Applications: February 1 Postmark

Submit the original and one copy of all application materials. Information will be used only to evaluate applicants and will be kept confidential. Please type throughout and be sure to complete all items. Refer to brochure or web site for further information.

1.	Name	____________________________________ Social Security #_____________________
2.	Present Position	_______________________________________________________________________
3.	Employer	_______________________________________________________________________
4.	Supervisor	__________________________________ Telephone (______) ____________________
5.	Office Address	_______________________________________________________________________
6.	Home Address	_______________________________________________________________________
7.	Preferred Mailing Address Please circle: Office or Home
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 · Position · Immediate Supervisor · Annual Salary
20.	Provide a typed intellectual autobiography of up to 2,000 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 1,000 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.	Indicate a preference for a specialty fellowship below. All applicants will automatically be considered for general fellowships. __________________________________________________________________________
23.	Provide examples of your professional work. Do not use scrapbooks or presentation folders. No entry materials will be returned. Provide three copies of each sample. Print journalists: Send up to five articles or photographs. Clippings must be dated and legible. Mount entries or photocopies flat on 8-1/2 x by 11” paper or send the on-line version as a print-out. No fold-overs. Do not 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. Also, include a brief typed description of the work on the disk, including date aired, and a typed statement of up to 500 words describing your work, including major programs for which you have been responsible.
24.	Two confidential letters of reference, one personal and one professional, mailed directly by the writers. 1. __________________________________________________________________________ 2. __________________________________________________________________________ List names and affiliations.
25.	A confidential letter from your immediate supervisor (if applicable) elucidating your qualifications for a Knight-Wallace Fellowship. __________________________________________________________________________ __________________________________________________________________________ List name and title.
26.	A letter from your employer (if applicable) supporting your application and granting you leave for the 1998-99 academic year if you should be offered a fellowship. __________________________________________________________________________ __________________________________________________________________________ List name and title.
Note: 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? __ Magazine advertisement __ Brochure __ Friend/employer __ Internet __ Other: ________________________________________________ Send application to: Charles R. Eisendrath, Director Knight-Wallace Fellows Mike and Mary Wallace House 620 Oxford Road University of Michigan 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, 313-763-0235, TDD 313-747-1388, FAX 313-763-2891.