Note: Applications are accepted and considered based on eligiability, order of arrival, and availability of funds.
A
pplication for Diversity Fellowship
Tennessee Technological University
Name ____________________________________________ Student ID “T” No. ________________
Last First Middle
Address _________________________________________________ Phone _____________________
Street City State Zip
Email Address Date of Birth
Undergraduate Major
Major Area of Study ________________________________ Degree Sought______________________________
If awarded a fellowship, would you be able to carry out all necessary assignments and perform them in a safe manner?
Yes No If no, please explain __________________________________________________
Educational Background (Use additional sheets if necessary)
College or University Address Dates Attended Degree
Employment History: List any current and recent (last 3 years) full-time, part-time, or summer employment and
briefly describe your responsibilities. Also include the hours per week and the dates of employment (use
additional sheets if necessary).
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Are you an employee of the State of Tennessee or of any county in Tennessee? Yes No
List any current and pending support for your education.
_________________________________________________________________________________________________
List three people whom we may contact concerning your qualifications for the position for which you are applying.
Name Occupation or Title Address Phone
On a separate page, explain why you are eligible and applying for the Diversity Fellowship (Refer to guidelines
posted at the link www.tntech.edu/graduatestudies/financial/diversity-fellowship)
Signature of Applicant____________________________________________________ Date _________________
Submit application to: College of Graduate Studies
Tennessee Technological University
P. O. Box 5012
Cookeville, TN 38505
Telephone: (931) 372-3233
Fax: (931) 372-3497
Email: gradstudies@tntech.edu
www.tntech.edu/graduatestudies
www.facebook.com/TTUGraduateStudies
www.twitter.com/TTU_GradSchool
Updated: November 2014
click to sign
signature
click to edit
![]()
