Continuation of University Support for Continuing Fulbrighter

Fulbright Student Information

Student Name fdg Home Country asfd
University Information
Institution Name adf Academic or Calendar Year for Awards afd
University Representative Completing Form
Name dsf Title
Email address dsafd Phone #
Signature Date

University Awards Select Additional Information

TUITION Award: (Select only ONE)
Full Tuition Award
Non-Resident Tuition Award
Partial or Flat Tuition Award Specify Amount, Percentage, or Credits Awarded:
No Tuition Award
FEE Awards: (Select any applicable)
Required Student Fee(s) Specify Amount or Percentage if partially covered:
University Health Insurance Fee Specify Amount or Percentage if partially covered:
SUMMER Funding Awarded: (Select one)
Yes No Specify type, year, amount, and requirements for receipt of award:
adsf
FELLOWSHIP and/or OTHER Funding Awarded: (Select one)
If a fellowship or other awards are offered, specify the type, amount, and requirements for receipt of award:

Terms of the University Awards

Enrollment Status Required for Awarded Year:
Minimum # credits needed to receive award(s): (if full time study is required, write full time)
Do award(s) cover online coursework? Y / N Specify any exceptions:
Are the university award(s) listed above renewable for subsequent academic year(s): (Select one)
Yes No Specify requirements:

Assistantship (if applicable) Required Information

Position Title:
Salary:
Dates of Employment:
Number of hours per week:
Work Address:
Immediate Supervisor:
Supervisor Confirmation:
(Required)
Position description,
including goals or
objectives:
Department:
$ Frequency: (per hour, per week, per month, etc.)
Starting Date: dsaf Ending Date:
Ending
(Do notDate:
enter a range)
Name and Title:
Phone Number and Email:
 The work will take place on campus; if not, please explain and provide the physical address
 The position will not require domestic or international travel; if travel is required, please provide itinerary
dates and locations