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(List languages you are fluent enough with to engage in university classes)
Are you a current GLEON member?
Yes
No
Pending
Note: You must be a student member of GLEON to receive a Site Exchange Travel Fellowship. You can apply
here.
Education
Current College/University Affiliation
Current Student Status
Full Time
Part Time
Other
If you picked other, please describe :
Current Degree Objective
Major Field
Expected Graduation Date (MM/DD/YYYY)
Letters of Recommendation
We require 2 letters of recommendation. One letter must be from your major advisor/supervisor and the other from your proposed research host. Please provide their names and emails below:
Advisor Name
Advisor Email Address
Advisor Phone Number
Host Name
Host Email Address
Host Phone Number
Proposed Travel
Site Name
Site City
Site State/Region
Site Country
Will the site exchange include international travel?
Yes
No
Is the site you are applying to GLEON affiliated?
Yes
No
If yes, list GLEON members at proposed site
Proposed Travel Schedule :
From (MM/DD/YYYY)
To (MM/DD/YYYY)
Purpose of Site Exchange
Describe the purpose of your site exchange (max 250 words)
Benefits of Student Travel Fellowship
Describe how a student travel fellowship will benefit you, the GLEON network, and your proposed host (max 500 words) Also indicate how the site exchange aligns with GLEON goals/directives, and how you intend to use the knowledge and experience you will acquire in future research, positions, professional activities, etc.
Signature
By entering your name below, you are signifying that all of the above information is true.
Name
Date (MM/DD/YYYY)
Wednesday, May 27, 2009
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