PERSONAL INFORMATION LAST NAME FIRST MIDDLE DATE OF BIRTH COUNTRY OF BIRTH GENDER (M/F) SOCIAL SECURITY NUMBER COUNTRY OF CITIZENSHIP VISA STATUS PERMANENT RESIDENT NUMBER (GREEN CARD HOLDERS) PERMANENT ADDRESS (NUMBER & STREET) PERMANENT ADDRESS (CITY, STATE, ZIP, COUNTRY) TELEPHONE PERMANENT E-MAIL Is this permanent address the same as your mailing address? yes no MAILING ADDRESS (if NOT the same as your permanent address) MAILING ADDRESS (NUMBER AND STREET) MAILING ADDRESS (CITY, STATE, ZIP, COUNTRY) ETHNICITY (OPTIONAL) The U.S. Department of Education requires that the University report on the racial composition of its student body. Self-identification by race is completely voluntary, and information on individual students is held in strict confidence by the University and the Program. Asian (Nation of origin: ) Hispanic (Nation of origin: ) Native American (Indian, Eskimo, Aleut) ) African American Caucasian Other ( please specify:
PREVIOUS EDUCATION HIGH SCHOOL DATES OF ATTENDANCE FROM (MM/YYYY) TO (MM/YYYYY) LOCATION (CITY, STATE, COUNTRY) UNDERGRADUATE INSTITUTION DEGREE MAJOR LOCATION (CITY, STATE, COUNTRY) STATUS (IN PROGRESS, COMPLETED) DATES OF ATTENDANCE (MM/YYYY) TO (MM/YYYYY) GRADUATE INSTITUTION DEGREE (INCLUDE SPECIALIZATION) LOCATION (CITY, STATE, COUNTRY) STATUS (IN PROGRESS, COMPLETED) DATES OF ATTENDANCE (MM/YYYY) TO (MM/YYYYY)
APPLICATION DATA Please check the program, subprogram which you wish to apply: Certificate Program in Conservation Biology General program Specialization in the Economics, Management and Finance of Env l Conservation CERC Teacher Training Institute NY/Hudson Valley Caribbean Summer Ecosystem Experiences for Undergraduates (SEE-U) Brazil Caribbean NY/Hudson Valley Are you a full-time employee of one of the CERC partner institutions (Columbia University, American Museum of Natural History, The New York Botanical Garden, Wildlife Conservation Society, Wildlife Trust)? yes no Are you a volunteer for one of the CERC partner institutions? yes no How many hours per month do you volunteer? Supervisor: Phone: Do you plan to enroll in other courses at Columbia during our program? If yes, when and in what division? How did you hear about the Program to which you are applying? Postcard Email Flyer Print ad Word-of-mouth Website Other: EMPLOYMENT CURRENT OR MOST RECENT JOB POSITION FROM/TO EMPLOYER EMPLOYER ADDRESS EMPLOYER CONTACT AREA CODE/TELEPHONE
SUPPORTING MATERIALS Please attach the following items and submit them with your application: Current resume or CV Letter of Reference with attached form One-page statement of interest Fellowship form (if you plan to apply for aid) Transcript (unofficial copies are permissible) $45 application fee (payable by check or money order to Columbia University ) Overview of Supporting Materials STATEMENT OF INTEREST A statement of interest is required for all applicants as follows: CERC Teacher Training: (500 words or less)-- please describe why you wish to take this course and how you imagine it will enhance your teaching. SEE-U (500 words or less) Briefly describe why you are choosing to study at your preferred location. Certificate: please describe your motivations for attending the program, and any experiences that support your qualification to attend the program or demonstrate your motivation. TRANSCRIPTS A copy of your most up to date transcripts is required for all applicants to all programs. Unofficial copies of transcripts are sufficient, such as online grade listings from your home institution. RESUME/CV An up to date CV or resume is required by applicants to all programs. APPLICATION FEE An application fee of US $45.00 must accompany all applications. This fee should be submitted by US check or money order, payable to Columbia University. ALL APPLICATION MATERIALS SHOULD BE SENT TO: CERC Morningside Programs 1200 Amsterdam Avenue, MC5557 10th Floor Schermerhorn Ext. New York, NY 10027 212-854-8179 tel. 212-854-8188 fax cerc@columbia.edu
FELLOWSHIP APPLICATION Partial scholarships are available for qualified applicants for all of our Programs The fellowship application form below must be submitted with your admissions application. Before answering the questions below, please give the following matters careful consideration: Some applicants ask not to be considered for a fellowship in the belief that requesting it may have an adverse effect on admission. This is not the case. Whether or not a student asks to be considered for fellowship aid has no bearing on the admission decision. In some instances the financial resources of applicants are such that they do not need fellowship aid and they are prepared to relinquish their right to be considered so that other meritorious applicants with financial need may benefit. Please check all that apply: I need fellowship aid in order to attend the Program $ (please indicate amount based on total Program cost). I receive financial support for professional development: my employer my school other source (Americorps, Peace Corps, etc.) I receive financial support for higher education: workstudy eligible aid for tuition (not student loans) gov t aid (Stafford, Perkins, TAP, etc.) If you are claimed as a dependent by a parent or guardian, they must fill out this form. If you are independent, please provide your own financial information. The financial information on this form pertains to: My parent/guardian Myself If you answered parent/guardian please provide: Parent/guardian name Last name, First name Parent/guardian contact number Phone w/area Code
FELLOWSHIP APPLICATION (TO BE COMPLETED BY PARENT/GUARDIAN IF THEY DECLARE YOU AS A DEPENDENT) INCOME AND ASSETS Please describe the annual income you receive from the following sources: Your yearly gross salary Spouse or domestic partner yearly gross salary Support from family Investments/Assets/Savings Stocks/Bonds/other Real Estate (current value of home etc.) Trusts FINANCIAL OBLIGATIONS Monthly housing payment (rent/mortgage/maintenance) Number of children/dependents Please list their ages: EDUCATIONAL DEBT Government Subsidized and Unsubsidized Loans Private loans Other Financial Considerations you d like to share:
CANDIDATE: RECOMMENDATION FORM LAST NAME FIRST MIDDE RECOMMENDER INFORMATION: LAST NAME FIRST MIDDLE INSTITUTION CURRENT ADDRESS (NUMBER AND STREET) CITY STATE ZIP COUNTRY TELEPHONE EMAIL SIGNATURE Please use this form to submit your opinion of the applicant s qualifications to participate in the designated CERC Program (see below). Please note: This recommendation must be submitted by the appropriate deadline. CERTIFICATE PROGRAM in Conservation Biology: please speak to the applicant s ability to undertake university-level work, and/or demonstrated commitment to conservation and environmental issues. SEE-U PROGRAM : to be completed by a dean, faculty advisor or instructor. CERC TEACHER TRAINING INSTITUTE: a letter of support to be completed by principal or school head, or faculty advisor. The Center for Environmental Research and Conservation (CERC) reserves the right to contact recommenders to obtain additional information and to verify the authenticity of the recommendations. In addition, this recommendation may be used in the selection process of certain external scholarships/fellowships eligible to applicant. Please type your reference and attach it to this page. Thank you.