Application for Faculty Education Assistance Grant

FEAG program awards are intended to support the faculty to pursue degrees other than a D.C. degree at institution other than Palmer. Faculty with the rank of Assistant Professor and above with three years of tenure at Palmer are eligible for the grant.

SECTION 1 PERSONAL DATA

Full Name: _____________________________________________________________________________

Last First Middle

Home Address: _____________________________________________________________________________

Street City State, Zip Code

Home Phone: (___) ______ - ________

Present Academic Rank: ___________________ Department: _______________________________________

Date of Appointment: _____________________ Department: _______________________________________

(if different than above)

Office Phone Extension: ___________________ E-mail address: ____________________________________

SECTION II EDUCATIONAL BACKGROUND

List all undergraduate and graduate college and universities attended, starting with the most recent and working backwards. Include only courses completed which could be applied towards a degree program at an accredited institution. Attach a separate sheet if necessary. Use 4.0 basis for GPA.

College/University City/State Dates Credits/ Date Earned GPA

From – To Degree or Expected

_____________________________________________________________________________________________

______________________________________________________________________________

_____________________________________________________________________________________________

Have you taken Miller’s Analogies test? ____ Y/N. If yes, date _______________ Score_____________________

Have you taken GRE? ____ Y/N. If yes, date taken ______________ Score ______________________________

Have you ever enrolled in any previous graduate level coursework subsequent to the awarding of your last degree? ______Y/N. If yes, please indicate below the course or courses, and if these courses will be transferred to your anticipated program of study for which you are applying now.

Course Title Credit Hours College/University Transfer Y/N

_____________________________________________________________________________________________

SECTION IV SPECIALIZED TRAINING

Course or Location Dates Total Diploma or

Seminars Attended Classroom Hrs. Certificate Earned

_____________________________________________________________________________________________

SECTION V PROFESSIONAL LICENSES AND/OR CREDENTIALS

Name of License Issuing Agency Date of Issue Expiration Date

_____________________________________________________________________________________________

SECTION VI TEACHING EXPERIENCE

Starting with most recent, other than Palmer, list all the colleges/universities where the applicant has taught.

College/University City/State Department Dates

_____________________________________________________________________________________________

SECTION VII CURRENT STUDY PROGRAM INFORMATION

Please supply the information related to this application.

Degree/Certification: ___________________________________________________________________________

College/University: _______________________________________________________________________________________

Enrollment Status: ____Full-time ____ Part-time ____ Resident ____ Non-resident

Leave Status _____ None ____________ Release time ________________________________________________________ (% release time/Sabbatical/other arrangement)

Projected Term of Study __________________________ Projected completion date __________________________________

Total Number of Credits Required __________________ Cost per Credit Hour ______________________________________

Other Fees ________________________ Total Cost of Study _______________________________________________

VIII JUSTIFICATION

In the space below, provide a narrative in support of this application; include justification and pertinence of this study as it applies to your current faculty position at Palmer.

I have read and fully understand the terms and conditions related to the Faculty Education Assistance Grant Program, and hereby make application for the grant. I hereby certify that the information provided in this application is accurate and complete.

Faculty: _________________________________ (signature) Date: ______________________________

Approved ____ Denied ____ Signature _______________________________ Date: ______________