HENRY FELLOWSHIP

Yale University
Application Form
______________________________________________________

This form and the accompanying materials must be received by the Henry Fellowship Committee on or
before the campus deadline. Post to: Henry Fellowship Committee, c/o Office of Fellowship Programs,
Box 208351 Yale Station, New Haven, Connecticut 06520-8351, or hand-deliver to the Fellowship
Program Office, 55 Whitney Avenue, Room 309.

This form may be completed through Adobe Reader.

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Date ________________________________

1. Name in full ________________________________________________________________________

Student ID#: ______________________________

2. Present mailing address ______________________________________________________________

Residential College or street address ____________________________________________________

___________________________________________________Phone _________________________

3. Permanent home address _____________________________________________________________

4. Phone _________________________

5. E-Mail Address _________________________________

6. (a) Date and place of birth ____________________________

(b) If naturalized, how and when did you become a citizen of the U.S.?

__________________________________________________________________________________

7. Marital status _______________________________________________________________________

8. Attach a description of your proposed course of study in England. If you propose original research,
outline your plan. If you contemplate staying on after the Fellowship year to take a higher degree, please
indicate. Be as specific as possible about what you want to achieve during the year, but it is not necessary
to list the exact courses that you would take. USE NO MORE THAN 1000 WORDS.
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9. Secondary (high school) attended:

(a) List school, giving location and dates of attendance.

______________________________________________________________________________

______________________________________________________________________________

(b) List any positions of authority you held, distinctions you attained, and sports or school societies in
which you participated.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

10. Colleges or universities attended (if necessary, attach a one to two-page résumé giving the details of
activities, honors, and awards, including leadership roles):

(a) List institution(s) and degrees, with dates.

______________________________________________________________________________

______________________________________________________________________________

(b) List any academic honors, scholarships, and fellowships received.

______________________________________________________________________________

______________________________________________________________________________

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(c) List your recreational and extracurricular interests and activities.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________
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11. You may attach samples of written work or publications related to your proposed field of study.

List these attachments here.

______________________________________________________________________________

______________________________________________________________________________

12. List any extracurricular activities in which you might wish to participate during the Fellowship year.

______________________________________________________________________________

______________________________________________________________________________

13. What are your career plans after the year of the Fellowship?

14. Give any other information likely to be of interest to the Selection Committee or to the Trustees of the
Henry Fund.

15. (a) Have you applied for admission to either Cambridge or Oxford?

Yes ______ No ______

If so, give details.

______________________________________________________________________________

______________________________________________________________________________

(b) Have you applied for any other scholarship or fellowship for study in a university?

Yes ______ No ______

If so, give details, including current status of application(s).

_____________________________________________________________________________

_____________________________________________________________________________

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16. List the names and addresses of three persons from whom you are requesting references.

(1) ______________________________________________________________________________

______________________________________________________________________________

(2) ______________________________________________________________________________

______________________________________________________________________________

(3) ______________________________________________________________________________

______________________________________________________________________________

It is understood that I may not read the letters of recommendation I have requested for the
Henry Fellowship, and that I will not seek to do so either while I am enrolled at Yale, or
subsequently.

Signature: __________________________________________Date:____________________

Statement that your application is approved and supported by the Dean of your Residential College:

_________________________________________________________________________________

__________________________________ ________________________________________

College Dean's Signature

________________________________________

Applicant's Signature

APPLICATION NOT VALID UNLESS SIGNED BY APPLICANT