Fellowships Awards Panels Vita Form

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Fellowships Awards Panels Application/Vita Form

Instructions: Please fill out this form online and submit it using the "Send Form" button.

IMPORTANT NOTE: You are limited to 1,000 words. Anything over 1,000 words will not be accepted.

All panelists must be based in the United States or Canada, as AAUW is financially unable to bring panelists to the United States from other countries.

Fields in bold are required.

Name

Street address

Line 2

City

State

ZIP

Home phone

Business phone

Fax

E-mail*

*To receive a copy of your submission enter your email above.

EDUCATION: (Please list institution, degree, year conferred, and field)

HONORS AND AWARDS

ACADEMIC AREAS YOU ARE ABLE/WILLING TO REVIEW

Specific Field :

Related Fields

RESEARCH and/or PROFESSIONAL EXPERIENCE (Starting with present position)

PUBLICATIONS (starting with most recent publication)

MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS

CIVIC, COMMUNITY, OR PROFESSIONAL ACTIVITIES RELATED TO WOMEN'S ISSUES

AAUW EXPERIENCE

Preference:

	American Awards Panel
	International Awards Panel (Applicants must be from the U.S. or Canada, as AAUW is financially unable to bring panelists to the U.S. from other countries.)
	Selected Professions
	Any

Optional: To help the Foundation ensure that there is diversity on all committees and panels, please indicate the underrepresented group of which you are a member, as stated in AAUW's Diversity Statement: In principle and practice, the Foundation values and seeks diversity. There shall be no barriers to full participation in this organization on the basis of gender, race, creed, age, sexual orientation, national origin, or disability.

SIGNATURE OF RECOMMENDER: (OPTIONAL)**

TITLE:

**Recommender not required for self-nomination.

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