**NATIONAL SCIENCE FOUNDATION**

**Division of Graduate Education -- Room 907N**

**Arlington, VA 22230**

**DECLARATION TO UTILIZE, RESERVE OR TERMINATE A SUBSEQUENT**

**YEAR OF A 3-YEAR GRADUATE FELLOWSHIP AWARD**

**FY 2002**

TO: All NSF Graduate and Minority Graduate Research Fellows.

Continuation of the 3-year National Science Foundation Fellowship
awarded to you in a prior year is contingent upon:

1\. Certification, each year following the first year of tenure, by the
Coordinating Official of your fellowship institution,

> that you are engaged in either (a) fellowship activities and making
> satisfactory academic progress toward an advanced
>
> science degree, or (b) institutionally approved non-fellowship
> activities.

2\. The availability of funds for continued support.

Unless the Foundation notifies you to the contrary, you may assume that
your request for 2002-2003, as indicated in Section A and when properly
certified by your Coordinating Official, has been approved.

Please advise your fellowship institution as to your wishes by
completing Section A of this form and returning two copies to the

Coordinating Official at your institution NOT LATER THAN April 1, 2002.
ALL FELLOWS, WHETHER THEY ARE ON MILITARY OR MEDICAL DEFERRAL, RESERVE
OR TENURE MUST COMPLETE THIS FORM OR THEIR FELLOWSHIP MAY BE TERMINATED.

**SECTION A. (To be completed by Fellow)**

I request that my 3-year award be:

1\. Continued for 2002-2003. **If returning to active tenure after a
period of reserve, my plan for the NSF fellowship during**

> **academic year 2002-2003 is to: \_\_\_\_\_\_ Begin tenure in the
> Summer Term \_\_\_\_\_\_ Begin tenure in the Fall Term**

Note: Continuation requests will be approved for 12 months.

2\. Reserved for 2002-2003 in order to engage in activities specified on
the reverse (Section C).

3\. Terminated for the reasons stated on the reverse (Section C). I
understand that this action ends my fellowship award.

I have a special need to study or do research full-time at a foreign
site for at least 3 continuous months; I have discussed this

with the Coordinating Official of my fellowship institution. The
allowance can be used at any appropriate time once tenure has begun and
within the five years during which fellowship tenure may be used.

I hereby apply (check box) for a one-time \$1,000 International Research
Travel Allowance for 2002-2003, as stated on the reverse side. (Section
C)

My current\* graduate degree program is in
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ at
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Field) (Institution)

in the Department of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
under the direction of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

who is my Scientific Advisor Department Chairman.

\*If field of study or institution is changed for 2002-2003, please
specify:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
A major change in the field of study must receive the approval of the
Coordinating Official and the National Science Foundation.

My name has changed since I received an NSF Fellowship. Please indicate
effective date and reason for the change.

Former
name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

I understand and agree that the fellowship is subject to the provisions
set forth in the booklet entitled **INFORMATION FOR GRADUATE RESEARCH
FELLOWS** (and of any amendments or revisions thereto), which is
available online at <http://www.nsf.gov/grfp> under "Publications" and
which I have read. I further understand that if, before beginning tenure
in a subsequent year of the award, the institution withdraws its
certification of my satisfactory academic progress toward an advanced
science degree, the remaining tenure will be canceled.

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Mr.

Name (typed or printed) Ms.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

My present address is:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

My Internet e-mail address is
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

My current phone \# where I can be reached is
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**SECTION B. (To be completed by Coordinating Official)**

Fellow is making satisfactory academic progress toward an advanced
degree in science or engineering or is satisfactorily

carrying out the alternate activities plan approved last year, and I
approve the request for 2002-2003 as indicated in Section A.

Fellow is NOT making satisfactory academic progress toward an advanced
degree in science or engineering or is NOT

satisfactorily carrying out the alternate activities plan approved last
year, and I CANNOT APPROVE the request for

2002-2003 as indicated in Section A.

Fellow was in a reserve status during the 2001-2002 fellowship year.

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**COORDINATING OFFICIAL**

Name, Title and Institution (typed or printed)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**SECTION C. ( To be completed by Fellow if necessary)**

Check one:

I am requesting that my 3-year fellowship be reserved for the reasons
described below.

I am terminating my 3-year fellowship for the reasons described below.

I plan to study or do research at the following foreign site(s) on the
dates indicated.

Note: One copy of this form completed for each Fellow is to be returned
to the Foundation by the Coordinating Official prior to

April 30, 2002. Failure to submit a form for each Fellow may result in
delay of a new grant to your university.

THE INSTITUTION AND THE FELLOW SHOULD EACH RETAIN ONE FILE COPY OF THIS
DECLARATION