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Research Exchange
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Fellowship Application
Name
*
Address
*
Phone
*
Numbers only. Do not include hyphens or parentheses.
E-mail
*
U.S. Citizen?
*
Yes
No
Ethnicity
*
Gender
*
Academic appointment
*
Institution granting Ph.D.
*
Discipline and sub-discipline of Ph.D.
*
Date Ph.D. completed or expected
*
Year
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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22
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24
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30
31
Name of your thesis advisor
*
Institutional affiliation of your thesis advisior
*
E-mail address of thesis advisor
*
Please provide a one-page abstract of your Ph.D. thesis in PDF format
*
Files must be less than
2 MB
.
Allowed file types:
pdf
.
Informative title of your proposed research
*
Discipline and sub-discipline of proposed research
*
Please provide a 700-1,000 word statement describing your proposed research in PDF format
*
Files must be less than
2 MB
.
Allowed file types:
pdf
.
Please provide a 500-700 word statement describing your educational background and personal experience in PDF format
*
Files must be less than
2 MB
.
Allowed file types:
pdf
.
Please provide your Curriculum Vitae in PDF format
*
Files must be less than
2 MB
.
Allowed file types:
pdf
.
Please provide a sample publication or unpublished research paper in PDF format
*
Files must be less than
2 MB
.
Allowed file types:
pdf
.
Name of faculty member at a California Alliance campus who has agreed to serve as your mentor
California Alliance campus of proposed mentor
UC Berkeley
UCLA
Stanford
Caltech
Academic department of proposed mentor
E-mail address of proposed mentor
How did you hear about the program?
*
Announcement in paper or journal
A website
An announcement via email
A faculty member or university office
Students or friends
Is this the first time you are applying for a California Alliance Fellowship?
*
Yes
No
Are you applying for other grants or fellowships?
*
Yes
No
Additional Mentors
If you have had the opportunity to discuss working with any additional faculty at the four California Alliance institutions or their affiliated National Labs as a Postdoc, feel free to list their names and institutions here.
