Emerging Leader Fellows Program

Application for Fellowship

Please fill out the application below and return it to Radha Pyati via email (rpyati@uccs.edu) or campus mail (Department of Chemistry, SB1) by Monday, October 29, 2007.

Name: _________________________________________________________________

Title or Rank:  __________________________________________________________

Unit:  __________________________________________________________

Email Address:  ___________________________ Telephone Number_______________

Campus Address _________________________________________________________

Essay. Please answer the following essay question in a separate document.

How would the Emerging Leader Fellows Program enhance your professional development and career goals?

Project Choices. Please review the Project Frameworks on the ELF website (http://www.uccs.edu/~rpyati/ELF/ ) and indicate your first, second, and third choices below using the codes on the website.

First Choice  ____________________

Second Choice ____________________

Third Choice _____________________

Supervisor: If the person named above is selected to be an Emerging Leader Fellow, their time on the Fellowship will be compensated in your unit in two possible ways. Faculty members will receive one course offload; staff members will work with you, their project Mentor, and the Chancellor to create a customized plan for their time that is acceptable to everyone.

I support the candidacy of the person named above for the Emerging Leader Fellows Program and will work with her/him, her/his project Mentor, and Chancellor Pamela Shockley-Zalabak to create an acceptable plan for replacement of her/his time taken away from regular duties.

Supervisor's Signature ____________________________________________

Supervisor's Name ________________________________________________

Supervisor's Title _________________________________________________