U.S Department of State
U.S. NATIONAL COMMISSION FOR UNESCO
LAURA W. BUSH TRAVELING FELLOWSHIP
DS-7646
05-2017
Application Coversheet
Step 1: Applicant Information
Last Name
First Name Middle Initial
Contact Email:
Contact Phone
Contact Address
Step 2: Proposal Information
Brief Title or Description of Your Proposed Program or Project
Proposed Country(ies) of Travel
Approximate Dates of Your Proposed Activity
I certify that this application is accurate and the materials I am submitting are my own work and complete to the best of my
knowledge.
Signature Date (mm-dd-yyyy)
OMB APPROVAL NO. 1405-0180
EXPIRATION DATE: 10/31/2020
ESTIMATED BURDEN: 10 hours
Public reporting burden for this collection of information is estimated to average 10 hours per response, including time required for searching existing data sources, gathering the necessary
documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB
control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: International Organizations, IO/UNESCO, 2121 Virginia
Ave, Suite 6200, Washington, DC 20037.
Checklist for Completed Application Package
Title of Your Proposal
1) Completed Application Coversheet
2) One page summary of proposal
3) Essay (up to 500 words, double spaced) stating interest in being considered for award
4) Current résumé
5) One page letter of recommendation
Reminder: All materials must be submitted electronically to the U.S. National Commission for UNESCO Executive Secretariat
(DCUNESCO@state.gov)
College/University Enrolled
U.S. Citizen: Yes No
AUTHORITIES: The information is sought pursuant to provisions in 22 USC 287o et seq., and 22 USC 2651a, 2656, 1431 et seq., and 2451 et seq.
PURPOSE: The purpose for soliciting the information is to determine the qualifications of fellowship applicants and their ability to undertake their proposed projects. In addition, it is used to select
the recipient of the fellowship.
ROUTINE USES: This information may be shared with the news media; to Government agencies and the White House for purposes of planning and coordinating public engagement activities; and to
Federal, state, and city governments which are issued tax reports, the Internal Revenue Service and the Social Security Administration which are sent tax and witholding data Routine Uses for the
system can be found in the System of Records Notice State-79, Digital Outreach and Communications.
DISCLOSURE: Providing this information is voluntary, however, failure to providethe information requested on this form will result in an incomplete application, and thus a declaration of ineligibility.
PRIVACY ACT STATEMENT
PAPERWORK REDUCTION ACT STATEMENT
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signature
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