**STUDENT APPLICATION**

**COMPLETING THE FELLOWSHIP APPLICATION FORM**

The fellowship application contains several sections. It is important
that you fill out the sections accurately.

***Student Data Section***

***All of the following components are REQUIRED for a complete
application:***

-   **College/University and School Residence** - complete these
    sections for the school that you are currently attending. Write
    "N/A" (not applicable) if you are not currently enrolled in a
    college or university. If your permanent address is the same as your
    school address write "same" on the permanent address line.

-   **Telephone Number** - a telephone number is requested for both your
    school and permanent residence. Please make sure that the telephone
    numbers listed are current. ORISE should be notified if your
    telephone number changes after your application is submitted.

-   **Educational Information** - list all the universities that you
    have attended. If you are currently enrolled in a graduate program,
    be sure to include it and your anticipated graduation date.
    **Transcripts should be provided for each university listed.** If
    you are already in graduate school, the undergraduate transcripts
    should clearly indicate completion of an undergraduate degree.

-   **GPA** - if university grading scale is other than 4.0 (for
    example, 5.0 or 6.0) please compute to 4.0.

-   **GRE** - list GRE scores if available at the time of application.
    GRE scores are **required** for a complete application. However, an
    official copy is still needed for the application file. Applicants
    should designate Oak Ridge Institute for Science and Education as a
    score report recipient, code number 1590, department number 00.
    **Because of testing schedules and deadlines, applicants are advised
    to seek GRE testing information early.** The generally scheduled
    test dates in October and December are acceptable; however, test
    scores from the February date will not be received in time for the
    application review.

-   **Participating University Choices** - select two university choices
    from the list of participating universities contained in this
    booklet. Whenever possible, a fellowship participant will be offered
    an appointment at the first choice university. Occasionally,
    however, the fellowship appointment may be offered at the second
    choice university. If an applicant's university preferences change
    after the application is submitted, ORISE must be notified
    immediately.

**Note: Selecting universities on the FES application is in no way
related to completing an application for entrance to a graduate program
at a specific university.**

***Current and Planned Courses***

List current academic year courses as well as planned courses for next
year. For example, a graduating senior would list, in the first half of
the table, all of the courses taken during the senior year. In the
bottom half of the table, the courses planned for the first year of
graduate school would be listed. If you do not know what courses you
will take during your first year of graduate school, you should contact
the coordinator at your first choice university to obtain a listing.

***Statement of Career and Academic Goals and Objectives***

Do not exceed more than one sheet for your career statement.

***References***

Three reference forms are enclosed. Please remember that references must
be returned to ORISE by the application deadline.

***Applications for Other Programs***

ORISE administers many other programs for the Department of Energy. Due
to the large number of applications received, we can no longer make
copies of an applicant's material in one applicant file for use in
another program file. **If applying to more than one program, an
applicant must submit separate application materials for each program.
This includes transcripts and reference forms. Only GRE scores will be
copied for the files.** While this represents a change in policy from
previous years, it provides more control to the applicant in ensuring
that each application file is complete for each program.

**Note: All parts of the application (including GRE scores) must be
received at Oak Ridge Institute for Science and Education by the last
Monday in January.** Late or incomplete applications will not be
reviewed for awards.

**FUSION ENERGY SCIENCES**

**GRADUATE FELLOWSHIP PROGRAM**

**NOTIFICATION OF INTENT TO APPLY**

Please fax or mail this notification form to the address below as soon
as possible after receiving this application form. Receipt of this form
will alert the FES Graduate Fellowship Office to expect an application
from you. (NOTE: You may also e-mail the information requested to the
FES Graduate Fellowship Office at the e-mail address listed below).

The FES Graduate Fellowship Office will place your notification on file
and will contact you if your application is not complete by January 30,
2006.

**NAME:** *First M.I. Last Ext.*

Please contact me regarding questions on my application at the
following:

**ADDRESS:** *Street Address City State Zip*

**PHONE:** **FAX (if available):**

**E-MAIL:**

\*Please determine which component of the FES Fellowship Program you
will be applying to by placing a check in the appropriate space provided
below**:**

> **Fusion Science** or **Fusion Technology**
>
> **Return this form to:**
>
> **Debbie Alcorn**

**FES Fellowship Program**

> **Oak Ridge Institute for Science and Education**
>
> **P.O. Box 117, MS 36**
>
> **Oak Ridge, TN 37831-0117**
>
> **Phone: (865) 576-3428**
>
> **Fax: (865) 241-5219**
>
> **E-mail: alcornd@orau.gov**

![](media/image1.png){width="2.2715277777777776in"
height="0.4666666666666667in"}

**FES APPLICATION CHECKSHEET**

  ---------------------------------------------------------------- ------
  **This checklist is provided to assist applicants in accurately  
  completing the application.**                                    

  The application form is either typed or printed neatly in black  
  ink.                                                             

  I have provided an address at which I may be reached after the   
  completion of the Spring 2006 semester (page 1).                 

  If a Permanent Resident Alien, a copy of my Alien Registration   
  Card (both sides) is attached (page 1).                          

  I have requested transcripts to be sent to ORISE from each       
  college or university I have attended (page 2).                  

  The undergraduate cumulative GPA I listed is a GPA from ALL      
  undergraduate universities I have attended (page 2).             

  The graduate cumulative GPA I listed is a GPA from ALL graduate  
  universities I have attended (page 2.)                           

  I have or will soon be taking the Graduate Record Examination    
  (page 2) which is **required** for this application.             

  I have defined my first- and second-choice universities. I have  
  labeled my first choice with a 1 and my second choice with a 2   
  in the left hand space. I have also listed the proposed academic 
  discipline and specific topic of interest for my first-and       
  second-choice universities (page 3).                             

  I understand that I must notify ORISE IMMEDIATELY if I wish to   
  change my first- and second-choice universities. I also          
  understand that once my application has been reviewed, I may not 
  change my preferences (page 3).                                  

  I have listed 3 individuals in the references section of the     
  application and I have given those individuals the reference     
  forms to fill out and return to ORISE. I understand that if      
  these reference forms are not received by ORISE by the           
  application deadline, my application will be considered          
  incomplete and I will not be considered for a fellowship award   
  (page 4).                                                        

  I have included page 6 in my application packet even if I have   
  not attended graduate school. I have marked the page with N/A if 
  I have not yet taken graduate courses.                           

  I have computed the overall GPA for all science, math and        
  engineering courses and have included it at the bottom of pages  
  5 and 6.                                                         

  I have filled out the Planned Courses section of the application 
  with all planned courses for the 2006-07 academic year (page 7). 
  THIS IS MANDATORY FOR A COMPLETE APPLICATION.                    

  I understand the purpose of the fellowship program and have      
  written my statement of career goals accordingly. On my          
  statement I have included my signature (page 8).                 

  I do not have to submit the Applicant Data Sheet, but I          
  understand that this information will not be given to those who  
  will be evaluating my application and the information I provide  
  will help ORISE assess their effectiveness in distributing       
  application to a diverse population.                             

  I have included the FES Fellowship Survey Form in my application 
  packet.                                                          
  ---------------------------------------------------------------- ------

**U.S. Department of Energy**

**Fusion Energy Sciences Fellowship Program**

**Fellowship Application**

Instructions: Refer to the current fellowship program description before
completing the application. Please note the deadlines for the receipt of
application materials by Oak Ridge Institute for Science and Education
(ORISE). ***Type or print all information clearly.***

**The following application components are REQUIRED:**

> 1\. Fellowship Application Form
>
> 2\. Current Official Transcript(s) from each university attended and
> Course Sheets
>
> Note: Transcript(s) must be mailed by the university to the address
> listed. If the applicant has already received a degree, the transcript
> should show evidence of the completion of the degree program.
>
> 3\. Statement of Career and Academic Goals and Objectives
>
> 4\. Three (3) Reference Forms. Have forms completed by faculty members
> and mailed directly to the address below. To return a reference form
> with the application packet, the applicant should have the person
> providing the reference place the form in an envelope, seal it and
> sign across the seal.
>
> 5\. Graduate Record Examination (GRE) Scores. **[No application will
> be reviewed without official GRE scores]{.underline}**. Have the
> Educational Testing Service send your GRE general aptitude scores
> directly to the address below. Seek GRE information promptly to ensure
> timely receipt of test results.

Please make sure that you have completed all parts of the application,
including your signature where requested. **Keep a copy of this
application and supporting materials for your files.**

***Deadline - January 30, 2006***

All information must be submitted by the application deadline. It is the
applicants responsibility to check with the Oak Ridge Institute for
Science and Education, FES office regarding the completeness of the
application file. Incomplete applications will not be reviewed. **Any
changes to the university preferences must be communicated to ORISE
immediately.**

***Applications for Other Programs***

ORISE administers many programs for the Department of Energy. **If
applying for more than one program, an applicant must submit separate
application materials for each program. This includes transcripts and
reference forms. Only GRE scores will be copied for files.**

***Return the completed application and any correspondence to:***

**Fusion Energy Sciences Fellowship Program**

**Oak Ridge Institute for Science and Education**

**Attention: Debbie Alcorn**

**P.O. Box 117, MS 36**

**Oak Ridge, Tennessee 37831-0117**

**Telephone: (865) 576-3428**

**Fax: (865) 241-5219**

**E-mail: alcornd@orau.gov**

**Application information will be used solely for the purpose of
selecting fellows and administering the program. Disclosure of this
information is made subject to Public Law 93-579 (the Privacy Act of
1974) and U.S. Department of Energy Regulations as published in the
Federal Register on September 30, 1977, ff.**

**FES STUDENT APPLICATION NAME:**

**APPLICANT DATA**

Applicant data is important in assessing the effectiveness of our
efforts to solicit applications from a diverse population. Your
completion and submission of this form will assist use in this regard,
however, your failure to do so will not affect our decision regarding
your application. We appreciate your cooperation:

**RACE**

> \[ \] Caucasian (*Having origins in any one of the original peoples of
> Europe, North Africa, or the Middle East*)
>
> \[ \] African American (*Having origins in any of the Black peoples of
> Africa*)
>
> \[ \] Hispanic (*Of Mexican, Puerto Rican, Cuban, Central/South
> American or other Spanish culture of origin, regardless of race*)
>
> \[ \] American Indian (*Having origins in any of the original peoples
> of North America, and maintaining cultural identification through
> tribal affiliation or community recognition*)
>
> \[ \] Asian or Pacific Islander (*Having origins in any of the
> original peoples of the Far East, Southeast Asia, the Indian
> Subcontinent, or the Pacific Island - for example, India, China,
> Japan, Koreas, Philippine Islands, and Samona*)

**SEX** \[ \] Female \[ \] Male **BIRTHDATE**

Month/Day/Year

Physical/Mental handicap (*physical or mental impairment that
substantially limits one or more major life activities - for example,
blindness, deafness, or mobility impairment*): \[ \] Yes \[ \] No

  ------------------------ ---------- -- --- -- -- -- --- -- -- --- ------- --- -------- -- ------- ----- ----------- -- -- -- -- -- -- -- ------- ------- -- ------- -- ---------- -----
  **U.S. DEPARTMENT OF                                                                                                                                                              
  ENERGY**                                                                                                                                                                          

  **FUSION ENERGY SCIENCES                                                                                                                                                          
  FELLOWSHIP PROGRAM**                                                                                                                                                              

  **STUDENT APPLICATION**                                                                                                                                                           

  **STUDENT DATA** (Please                                                                                                                                                          
  type or print using                                                                                                                                                               
  black ink)                                                                                                                                                                        

                                                                                                                                                                                    

                                                                                                                                                                                    

  Name                                                                                                                                                                              

                           (First)                                                                                                                                                  
                           (Middle)                                                                                                                                                 
                           (Last)                                                                                                                                                   
                           (Ext)                                                                                                                                                    

  Social Security Number                                                                                                                                                            

                                                                                                                                                                                    

  Current Academic Status:                                                                                                                                                          

  \[ \] Undergraduate                                                                                                                                                               
  Student                                                                                                                                                                           

  \[ \] Graduate Student                                                                                                                                                            

  \[ \] Baccalaureate                                                                                                                                                               
  Recipient Not Currently                                                                                                                                                           
  Enrolled                                                                                                                                                                          

  \[ \] Other                                                                                                                                                                       

                                                                                                                                                                                    

  Number of Years of                                                                                                                                                                
  Graduate studies (all                                                                                                                                                             
  disciplines and years)                                                                                                                                                            
  that will be completed                                                                                                                                                            
  by September 1, 2006                                                                                                                                                              

  *(Graduate Students who                                                                                                                                                           
  will have progressed                                                                                                                                                              
  beyond the end of their                                                                                                                                                           
  second year of graduate*                                                                                                                                                          

  *school studies by                                                                                                                                                                
  September 1, 2006 **are                                                                                                                                                           
  not eligible to                                                                                                                                                                   
  apply).***                                                                                                                                                                        

  **COLLEGE/UNIVERSITY**                                                                                                                                                            

                                                                                                                                                                                    

  Department                                                                                Major                                                                                   

                                                                                                                                                                                    

  City                                                              State                   Zip                                                               Phone                 

                                                                                                                                                                                    

  **SCHOOL RESIDENCE**                                                                                                                                                              

                                                                                                                                                                                    

  City                                                              State                           Zip                                            Phone                            

                                                                                                                                                                                    

  ***Address effective                                                                                                                                                              
  through:***                                                                                                                                                                       

  ***After this date, all                                                                                                                                                           
  correspondence will be                                                                                                                                                            
  sent to the permanent                                                                                                                                                             
  address listed below                                                                                                                                                              
  unless otherwise                                                                                                                                                                  
  requested.***                                                                                                                                                                     

  **PERMANENT ADDRESS**                                                                                                                                                             

                                                                                                                                                                                    

  City                                                              State                           Zip                                    Phone                                    

                                                                                                                                                                                    

  **FAX NUMBER**:                                                                                                                                                                   

  **E-MAIL:**                                                                                                                                                                       

                                                                                                                                                                                    

  **CITIZENSHIP**                                                                                                                                                                   

                                                                                                                                                                                    

  U.S. Citizen: \[ \]                                                                                                                                                               
  *Yes* \[ \] *No* If no,                                                                                                                                                           
  are you a Permanent                                                                                                                                                               
  Resident Alien: \[ \]                                                                                                                                                             
  *Yes* \[ \] *No*                                                                                                                                                                  

                                                                                                                                                                                    

  If PRA, Country                                                               PRA                                                                                                 
                                                                                Number                                                                                              

                                                                                                                                                                                    

  Country of Birth                                                              Port of                                                                                             
                                                                                Entry                                                                                               

                                                                                                                                                                                    

  **Attach copy of Alien                                                                                                                                                            
  Registration Receipt                                                                                                                                                              
  Card (both sides)**                                                                                                                                                               

                                                                                                                                                                                    

  **DEGREE PROGRAM**                                                                                                                                                                

  Ph.D. degree expected                                                                                                                                                             
  (date)                                                                                                                                                                            

                                                                                                                                                                                    

                                                                                                                                                                                    

                                                                                                                                                                                    

  **DISCIPLINE AREA:                                                                                      **Fusion                                                                  
  (choose one) Fusion                                                                                     Science**                                                                 
  Technology**                                                                                                                                                                      
  ------------------------ ---------- -- --- -- -- -- --- -- -- --- ------- --- -------- -- ------- ----- ----------- -- -- -- -- -- -- -- ------- ------- -- ------- -- ---------- -----

**FES STUDENT APPLICATION NAME:**

**EDUCATION**

List Technical Schools, Universities/Colleges. Begin with most current
institution. Please submit transcripts from each institution listed
below.

**Undergraduate Institution(s)**

+--------------+----------+---------+-----------------+-------+------+
| **I          | *        | **      | **DEGREE**      | **MON | **G  |
| NSTITUTION** | *DATES** | MAJOR** |                 | TH/** | PA** |
|              |          |         | **RECE          |       |      |
|              | **AT     |         | IVED/EXPECTED** | **Y   |      |
|              | TENDED** |         |                 | EAR** |      |
+--------------+----------+---------+-----------------+-------+------+
|              |          |         |                 |       |      |
+--------------+----------+---------+-----------------+-------+------+
|              |          |         |                 |       |      |
+--------------+----------+---------+-----------------+-------+------+
|              |          |         |                 |       |      |
+--------------+----------+---------+-----------------+-------+------+

**Graduate Institution(s)**

+--------------+----------+---------+-----------------+-------+------+
| **I          | *        | **      | **DEGREE**      | **MON | **G  |
| NSTITUTION** | *DATES** | MAJOR** |                 | TH/** | PA** |
|              |          |         | **RECE          |       |      |
|              | **AT     |         | IVED/EXPECTED** | **Y   |      |
|              | TENDED** |         |                 | EAR** |      |
+--------------+----------+---------+-----------------+-------+------+
|              |          |         |                 |       |      |
+--------------+----------+---------+-----------------+-------+------+
|              |          |         |                 |       |      |
+--------------+----------+---------+-----------------+-------+------+
|              |          |         |                 |       |      |
+--------------+----------+---------+-----------------+-------+------+

**GRADE POINT AVERAGE**

List the **cumulative** undergraduate and graduate GPAs for all
institutions listed above. Use 4.0 scale to compute (A=4, B=3, C=2,
D=1). If your institution uses a different grading scale other than 4.0
(*for example, 5.0 or 6.0*) recompute to 4.0. Please round to two
decimal places (for example: 3.55 or 3.90).

  ------------------ --- ------ -------------- ------------------------------------------
  Undergraduate                                (Include all institutions attended)
  Cumulative GPA                               
  (Include all                                 
  institutions                                 
  attended)                                    

                                               

  Graduate                      (Include all   
  Cumulative GPA                institutions   
  (Include all                  attended)      
  institutions                                 
  attended)                                    

                                               
  ------------------ --- ------ -------------- ------------------------------------------

**GRADUATE RECORD EXAMINATION** **([REQUIRED]{.underline})**

**Verification of these scores is required. (*Note: Official Graduate
Examination (GRE) Scores must be sent directly by the Educational
Testing Service to ORISE/Fusion Energy Sciences Fellowship Program.
ORISE's Institution Code is 1590, Dept. 00). The GRE is required for all
applicants.***

GRE TEST RESULTS TEST TAKEN/TO BE TAKEN (DATE)

  --------------------- --------------------- ---------------------------
  **EXAMINATION**       **SCORE**             **PERCENT (%)**

  **Verbal**                                  

  **Quantitative**                            

  **Analytical**                              
  --------------------- --------------------- ---------------------------

**Have you taken or passed the first set of competency graduate exams in
your discipline that is required at your academic institution \[ \] Yes;
\[ \] No. If yes, please list the name of this exam and the date you
passed it.**

**\[ \] Taken; \[ \] Passed**

**Name of Exam
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date
Passed
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**FES STUDENT APPLICATION NAME:**

**PARTICIPATING UNIVERSITY**

Place a 1 beside the university of your first choice and a 2 beside the
university of your second choice. Notice that there are designated
schools for the fusion technology component and designated schools for
the fusion science component of the FES Fellowship Program. ***If, after
submitting this application, you change your preferred university,
please notify ORISE immediately. Failure to do so will jeopardize your
award status.***

+-------------------------------------+--------------------------------+
| **FUSION TECHNOLOGY**               | **FUSION SCIENCE**             |
+-------------------------------------+--------------------------------+
| University of California - Berkeley | Auburn University              |
|                                     |                                |
| Georgia Institute of Technology     | California Institute of        |
|                                     | Technology                     |
| University of Illinois              |                                |
|                                     | University of                  |
| Massachusetts Institute of          | California-Berkeley            |
| Technology                          |                                |
|                                     | University of                  |
| University of Michigan              | California-Irvine              |
|                                     |                                |
| University of Wisconsin-Madison     | University of California-Los   |
|                                     | Angeles                        |
|                                     |                                |
|                                     | University of California-San   |
|                                     | Diego                          |
|                                     |                                |
|                                     | Columbia University            |
|                                     |                                |
|                                     | University of Maryland         |
|                                     |                                |
|                                     | Massachusetts Institute of     |
|                                     | Technology                     |
|                                     |                                |
|                                     | Princeton University           |
|                                     |                                |
|                                     | Rensselaer Polytechnic         |
|                                     | Institute                      |
|                                     |                                |
|                                     | University of Texas-Austin     |
|                                     |                                |
|                                     | West Virginia University       |
|                                     |                                |
|                                     | \_\_ University of Washington  |
|                                     |                                |
|                                     | University of                  |
|                                     | Wisconsin-Madison              |
+-------------------------------------+--------------------------------+

List your academic discipline and topic of interest for your first- and
second-choice universities.

+---------------------------------------+------------------------------+
| **FIRST UNIVERSITY CHOICE**           | **FIRST UNIVERSITY CHOICE**  |
|                                       |                              |
| **ACADEMIC DISCIPLINE**               | **TOPIC OF INTEREST**        |
+---------------------------------------+------------------------------+
|                                       |                              |
+---------------------------------------+------------------------------+
| **SECOND UNIVERSITY CHOICE**          | **SECOND UNIVERSITY CHOICE** |
|                                       |                              |
| **ACADEMIC DISCIPLINE**               | **TOPIC OF INTEREST**        |
+---------------------------------------+------------------------------+
|                                       |                              |
+---------------------------------------+------------------------------+

**EXTRACURRICULAR ACTIVITIES**

Include technical societies and service organizations (*include offices
held*)

  --------------------------------------- -------------------------------
                                          

                                          

                                          

                                          
  --------------------------------------- -------------------------------

**FES STUDENT APPLICATION NAME:**

**ACADEMIC AWARDS AND HONORS**

Include undergraduate and graduate honors (*if applicable)*.

+----------------------+---------------+------------------------------+
| **UNDERGRADUATE/**   | **UN          | **BRIEF DESCRIPTION**        |
|                      | DERGRADUATE** |                              |
| **GRADUATE HONORS**  |               |                              |
|                      | **OR          |                              |
|                      | GRADAUTE**    |                              |
+----------------------+---------------+------------------------------+
|                      |               |                              |
+----------------------+---------------+------------------------------+
|                      |               |                              |
+----------------------+---------------+------------------------------+
|                      |               |                              |
+----------------------+---------------+------------------------------+
|                      |               |                              |
+----------------------+---------------+------------------------------+

### PUBLICATIONS AND PRESENTATIONS 

List below all of your publications and presentations. If a
presentation, list if it was oral or a poster.

  ------------------------- ---------- --------------------------- ----------
  **TITLE**                 **DATE**   **CONFERENCE/JOURNAL**      **POSTER
                                                                   OR ORAL**

                                                                   

                                                                   

                                                                   

                                                                   
  ------------------------- ---------- --------------------------- ----------

**EMPLOYMENT RECORD**

Begin with current or most recent employment.

  ------------------------------ ------------- ----------------------------
  **EMPLOYER/JOB TITLE**         **FROM/TO**   **MAJOR AREAS OF
                                               RESPONSIBILITY**

                                               

                                               

                                               

                                               

                                               
  ------------------------------ ------------- ----------------------------

**REFERENCES**

List three persons familiar with your academic preparation and your
technical capabilities. Please have these individuals transmit the
attached reference forms directly to ORISE. A reference may be returned
with the student application packet if it is placed in a sealed envelope
with the reference's signature across the seal.

  -----------------------------------------------------------------------
  1\.

  2\.

  3\.
  -----------------------------------------------------------------------

**FES STUDENT APPLICATION NAME:**

**UNDERGRADUATE COURSES**

List all science, engineering, and mathematics courses that you have
completed at ALL undergraduate institutions listed in this application.
Provide course title and name, hours attempted, and letter grade. An
example is provided below. Use additional sheets if necessary.

  ---------------------- ----------- ----------- -------------------- ----------- -----------
  **COURSE NAME**        **HOURS**   **GRADE**   **COURSE NAME**      **HOURS**   **GRADE**

  **EXAMPLE:** **Plasma  **4**       **A**       **EXAMPLE: Fluid     **3**       **B**
  Physics I**                                    Dynamics**                       

  **ENGINEERING**        **HOURS**   **GRADE**   **ENGINEERING**      **HOURS**   **GRADE**

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  **SCIENCE**            **HOURS**   **GRADE**   **SCIENCE**          **HOUR**    **GRADE**

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

  **MATHEMATICS**        **HOURS**   **GRADE**   **MATHEMATICS**      **HOURS**   **GRADE**

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  
  ---------------------- ----------- ----------- -------------------- ----------- -----------

Grade Point Average for all undergraduate science, engineering and
mathematics courses. *GPA basis: A=4, B=3, C=2, D=1).* Round to two
decimal places.

**FES STUDENT APPLICATION NAME:**

**GRADUATE COURSES**

List all science, engineering, and mathematics courses that you have
completed at ALL graduate institutions listed in this application.
Provide course title and name, hours attempted, and letter grade. An
example is provided below. Use additional sheets if necessary.

  --------------------- ----------- ----------- -------------------- ----------- -----------
  **COURSE NAME**       **HOURS**   **GRADE**   **COURSE NAME**      **HOURS**   **GRADE**

  **EXAMPLE:**          **4**       **A**       **EXAMPLE: Fluid     **3**       **B**
  **Mathematical                                Dynamics**                       
  Physics**                                                                      

  **ENGINEERING**       **HOURS**   **GRADE**   **ENGINEERING**      **HOURS**   **GRADE**

                                                                                 

                                                                                 

                                                                                 

                                                                                 

                                                                                 

                                                                                 

                                                                                 

  **SCIENCE**           **HOURS**   **GRADE**   **SCIENCE**          **HOUR**    **GRADE**

                                                                                 

                                                                                 

                                                                                 

                                                                                 

                                                                                 

                                                                                 

                                                                                 

  **MATHEMATICS**       **HOURS**   **GRADE**   **MATHEMATICS**      **HOURS**   **GRADE**

                                                                                 

                                                                                 

                                                                                 

                                                                                 

                                                                                 

                                                                                 

                                                                                 
  --------------------- ----------- ----------- -------------------- ----------- -----------

Grade Point Average for all graduate science, engineering and
mathematics courses. (*GPA basis: A=4, B=3, C=2, D=1).* Round to two
decimal places.

**FES STUDENT APPLICATION NAME:**

**CURRENT AND PLANNED COURSES**

**COURSES FOR THE CURRENT ACADEMIC YEAR** (List all courses to be taken
during the 2005-2006 school year.)

If you are not currently enrolled in school and all of your completed
courses are listed on the transcript submitted with this application
then the Current Courses section does not apply (indicate N/A).

University:

+----------------------------------------+--------------------+-------+
| **COURSE NAME**                        | **STATUS**         | **HO  |
|                                        |                    | URS** |
| **Example: General Plasma Physics I**  | **CP = COMPLETED** |       |
|                                        |                    |       |
|                                        | **C = CURRENT**    |       |
|                                        |                    |       |
|                                        | **P = PLANNED**    |       |
+========================================+====================+=======+
|                                        |                    |       |
+----------------------------------------+--------------------+-------+
|                                        |                    |       |
+----------------------------------------+--------------------+-------+
|                                        |                    |       |
+----------------------------------------+--------------------+-------+
|                                        |                    |       |
+----------------------------------------+--------------------+-------+
|                                        |                    |       |
+----------------------------------------+--------------------+-------+
|                                        |                    |       |
+----------------------------------------+--------------------+-------+
|                                        |                    |       |
+----------------------------------------+--------------------+-------+
|                                        |                    |       |
+----------------------------------------+--------------------+-------+
|                                        |                    |       |
+----------------------------------------+--------------------+-------+

**THIS SECTION IS REQUIRED.**

**PLANNED COURSES FOR THE NEXT ACADEMIC YEAR** (List all courses to be
taken during the 2006-2007 school year.)

In this section, you should list courses totaling 18-24 hours of
full-time study. If you are not currently enrolled in graduate school,
it may be necessary for you to contact your first choice university to
obtain the required first year courses. Please type or print clearly.

University:

  ---------------------------------------------------------------------------
  **COURSE NAME**                           **COURSE NUMBER**     **HOURS**
  ----------------------------------------- --------------------- -----------
                                                                  

                                                                  

                                                                  

                                                                  

                                                                  

                                                                  

                                                                  

                                                                  
  ---------------------------------------------------------------------------

**FES STUDENT APPLICATION NAME:**

**STATEMENT OF CAREER AND ACADEMIC GOALS AND OBJECTIVES**

Submit a brief summary of your academic and career plans **(limit this
summary to one typed page).** Indicate the relationship between these
plans and the objectives of the fellowship program. For additional
information, visit the Office of Fusion Energy Sciences web site at
http://wwwofe.er.doe.gov/. [This statement should specifically address
your interest and plans for pursuing research in fusion science or
fusion technology.]{.underline}

**If you are a 2^nd^ year graduate student, please include a very clear
description of any research you undertook in the first year of graduate
school.**

**THIS STATEMENT IS VITAL TO THE OVERALL EVALUATION OF YOUR
APPLICATION.**

Signature Date

My signature acknowledges that I am aware that this program is supported
by funding from the United States Government, and therefore is subject
to Federal law regarding false statements and fraud, particularly the
criminal provisions of 18 U.S. code Section 1001. I certify, under the
penalty of law, that the original submitted student application contains
no false, fictitious or fraudulent representations, statements or
entries.

Fusion Energy Sciences![](media/image1.png){width="2.2715277777777776in"
height="0.4666666666666667in"}

Fellowship Program

**Reference Form**

Applicant (Please type or use black ink)

  -----------------------------------------------------------------------
  Last Name First Middle
  -----------------------------------------------------------------------
  How long and in what association have you known the applicant?

  -----------------------------------------------------------------------

In a group of 100 other science, engineering and math students of
comparable age and experience, how would you rate the applicant with
respect to the following PERSONAL CHARACTERISTICS?

+----------------------------+-----+-----+-----+-------+------+------+
|                            | Be  | A   | Ab  | O     | Supe | In   |
|                            | low | ver | ove | utsta | rior | adeq |
|                            |     | age |     | nding |      | uate |
|                            | A   |     | A   |       |      |      |
|                            | ver |     | ver |       |      | Obs  |
|                            | age |     | age |       |      | erva |
|                            |     |     |     |       |      | tion |
+----------------------------+-----+-----+-----+-------+------+------+
| *Motivation Toward a       |     |     |     |       |      |      |
| Productive Career*         |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Growth During Total       |     |     |     |       |      |      |
| Period Observed*           |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Imagination and           |     |     |     |       |      |      |
| Originality of Thought*    |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Emotional Maturity and    |     |     |     |       |      |      |
| Stability*                 |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Ability to Work with      |     |     |     |       |      |      |
| Others*                    |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Independence and          |     |     |     |       |      |      |
| Self-Reliance*             |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Leadership Potential*     |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+

In a group of 100 other science, engineering and math students of
comparable age and experience, how would you rate the applicant with
respect to the following SCIENTIFIC CAPABILITIES?

+----------------------------+-----+-----+-----+-------+------+------+
|                            | Be  | A   | Ab  | O     | Supe | In   |
|                            | low | ver | ove | utsta | rior | adeq |
|                            |     | age |     | nding |      | uate |
|                            | A   |     | A   |       |      |      |
|                            | ver |     | ver |       |      | Obs  |
|                            | age |     | age |       |      | erva |
|                            |     |     |     |       |      | tion |
+----------------------------+-----+-----+-----+-------+------+------+
| *Mastery of Fundamental    |     |     |     |       |      |      |
| Knowledge in Field*        |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Skill/Originality of      |     |     |     |       |      |      |
| Research Project Design*   |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Laboratory Skill and      |     |     |     |       |      |      |
| Technique*                 |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Ability to Communicate    |     |     |     |       |      |      |
| (Written/Oral)*            |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+

**Add any descriptive comments that will assist in providing a complete
picture of the applicant's character, attitude, abilities, and potential
for research. Please comment on both the applicant'**s weak and strong
points. Use additional sheets if necessary.

  -----------------------------------------------------------------------
  **COMMENTS:**
  -----------------------------------------------------------------------

  Signature: Date:

  Typed/Printed Name: Title:

  Address: Phone:
  -----------------------------------------------------------------------

**RETURN TO:** **Fusion Energy Sciences Fellowship Program, Oak Ridge
Institute for Science and Education, 120 Badger Avenue, MS 36, Oak
Ridge, Tennessee 37831-0117, Attention: Debbie Alcorn; Phone: (865)
576-3428; Fax: (865) 241-5219**

Fusion Energy Sciences![](media/image1.png){width="2.2715277777777776in"
height="0.4666666666666667in"}

Fellowship Program

**Reference Form**

Applicant (Please type or use black ink)

  -----------------------------------------------------------------------
  Last Name First Middle
  -----------------------------------------------------------------------
  How long and in what association have you known the applicant?

  -----------------------------------------------------------------------

In a group of 100 other science, engineering and math students of
comparable age and experience, how would you rate the applicant with
respect to the following PERSONAL CHARACTERISTICS?

+----------------------------+-----+-----+-----+-------+------+------+
|                            | Be  | A   | Ab  | O     | Supe | In   |
|                            | low | ver | ove | utsta | rior | adeq |
|                            |     | age |     | nding |      | uate |
|                            | A   |     | A   |       |      |      |
|                            | ver |     | ver |       |      | Obs  |
|                            | age |     | age |       |      | erva |
|                            |     |     |     |       |      | tion |
+----------------------------+-----+-----+-----+-------+------+------+
| *Motivation Toward a       |     |     |     |       |      |      |
| Productive Career*         |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Growth During Total       |     |     |     |       |      |      |
| Period Observed*           |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Imagination and           |     |     |     |       |      |      |
| Originality of Thought*    |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Emotional Maturity and    |     |     |     |       |      |      |
| Stability*                 |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Ability to Work with      |     |     |     |       |      |      |
| Others*                    |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Independence and          |     |     |     |       |      |      |
| Self-Reliance*             |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Leadership Potential*     |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+

In a group of 100 other science, engineering and math students of
comparable age and experience, how would you rate the applicant with
respect to the following SCIENTIFIC CAPABILITIES?

+----------------------------+-----+-----+-----+-------+------+------+
|                            | Be  | A   | Ab  | O     | Supe | In   |
|                            | low | ver | ove | utsta | rior | adeq |
|                            |     | age |     | nding |      | uate |
|                            | A   |     | A   |       |      |      |
|                            | ver |     | ver |       |      | Obs  |
|                            | age |     | age |       |      | erva |
|                            |     |     |     |       |      | tion |
+----------------------------+-----+-----+-----+-------+------+------+
| *Mastery of Fundamental    |     |     |     |       |      |      |
| Knowledge in Field*        |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Skill/Originality of      |     |     |     |       |      |      |
| Research Project Design*   |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Laboratory Skill and      |     |     |     |       |      |      |
| Technique*                 |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Ability to Communicate    |     |     |     |       |      |      |
| (Written/Oral)*            |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+

**Add any descriptive comments that will assist in providing a complete
picture of the applicant's character, attitude, abilities, and potential
for research. Please comment on both the applicant'**s weak and strong
points. Use additional sheets if necessary.

  -----------------------------------------------------------------------
  **COMMENTS:**
  -----------------------------------------------------------------------

  Signature: Date:

  Typed/Printed Name: Title:

  Address: Phone:
  -----------------------------------------------------------------------

**RETURN TO:** **Fusion Energy Sciences Fellowship Program, Oak Ridge
Institute for Science and Education, 120 Badger Avenue, MS 36, Oak
Ridge, Tennessee 37831-0117, Attention: Debbie Alcorn; Phone: (865)
576-3428; Fax: (865) 241-5219**

Fusion Energy Sciences![](media/image1.png){width="2.2715277777777776in"
height="0.4666666666666667in"}![](media/image1.png){width="2.2715277777777776in"
height="0.4666666666666667in"}![](media/image1.png){width="2.2715277777777776in"
height="0.4666666666666667in"}

####### Fellowship Program

**Reference Form**

Applicant (Please type or use black ink)

  -----------------------------------------------------------------------
  Last Name First Middle
  -----------------------------------------------------------------------
  How long and in what association have you known the applicant?

  -----------------------------------------------------------------------

In a group of 100 other science, engineering and math students of
comparable age and experience, how would you rate the applicant with
respect to the following PERSONAL CHARACTERISTICS?

+----------------------------+-----+-----+-----+-------+------+------+
|                            | Be  | A   | Ab  | O     | Supe | In   |
|                            | low | ver | ove | utsta | rior | adeq |
|                            |     | age |     | nding |      | uate |
|                            | A   |     | A   |       |      |      |
|                            | ver |     | ver |       |      | Obs  |
|                            | age |     | age |       |      | erva |
|                            |     |     |     |       |      | tion |
+----------------------------+-----+-----+-----+-------+------+------+
| *Motivation Toward a       |     |     |     |       |      |      |
| Productive Career*         |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Growth During Total       |     |     |     |       |      |      |
| Period Observed*           |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Imagination and           |     |     |     |       |      |      |
| Originality of Thought*    |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Emotional Maturity and    |     |     |     |       |      |      |
| Stability*                 |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Ability to Work with      |     |     |     |       |      |      |
| Others*                    |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Independence and          |     |     |     |       |      |      |
| Self-Reliance*             |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Leadership Potential*     |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+

In a group of 100 other science, engineering and math students of
comparable age and experience, how would you rate the applicant with
respect to the following SCIENTIFIC CAPABILITIES?

+----------------------------+-----+-----+-----+-------+------+------+
|                            | Be  | A   | Ab  | O     | Supe | In   |
|                            | low | ver | ove | utsta | rior | adeq |
|                            |     | age |     | nding |      | uate |
|                            | A   |     | A   |       |      |      |
|                            | ver |     | ver |       |      | Obs  |
|                            | age |     | age |       |      | erva |
|                            |     |     |     |       |      | tion |
+----------------------------+-----+-----+-----+-------+------+------+
| *Mastery of Fundamental    |     |     |     |       |      |      |
| Knowledge in Field*        |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Skill/Originality of      |     |     |     |       |      |      |
| Research Project Design*   |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Laboratory Skill and      |     |     |     |       |      |      |
| Technique*                 |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+
| *Ability to Communicate    |     |     |     |       |      |      |
| (Written/Oral)*            |     |     |     |       |      |      |
+----------------------------+-----+-----+-----+-------+------+------+

**Add any descriptive comments that will assist in providing a complete
picture of the applicant's character, attitude, abilities, and potential
for research. Please comment on both the applicant'**s weak and strong
points. Use additional sheets if necessary.

  -----------------------------------------------------------------------
  **COMMENTS:**
  -----------------------------------------------------------------------

  Signature: Date:

  Typed/Printed Name: Title:

  Address: Phone:
  -----------------------------------------------------------------------

**RETURN TO:** **Fusion Energy Sciences Fellowship Program, Oak Ridge
Institute for Science and Education, 120 Badger Avenue, MS 36, Oak
Ridge, Tennessee 37831-0117, Attention: Debbie Alcorn; Phone: (865)
576-3428; Fax: (865) 241-5219**

![](media/image1.png){width="2.2715277777777776in"
height="0.4666666666666667in"}![](media/image1.png){width="2.2715277777777776in"
height="0.4666666666666667in"}

**FES FELLOWSHIP SURVEY FORM**

Dear Applicant:

Please complete this form and return it with your fellowship
application. The information that you provide will allow us to target
our advertising more effectively. This information is confidential and
is **not** used in review of the fellowship application.

1\. How did you find out about the program?

\[ \] Bulletin Board Announcement

\[ \] Advertising in Journal (list name of journal)

\[ \] Word of Mouth

from \[ \] faculty \[ \] student \[ \] administrator

\[ \] Laboratory Staff

\[ \] Campus Recruitment

\[ \] Institutional Announcement

\[ \] Campus Newspaper

\[ \] Conference or Meeting (list name of meeting)

\[ \] Internet Site (please list name of site)

\[ \] Other (please list)

2\. Have you applied for other fellowship programs? \[ \] Yes \[ \] No

> If yes, please check the source below:

\[ \] From ORISE (names of fellowships)

\[ \] From other sources

\[ \] University-Sponsored (names of fellowships)

\[ \] Other (NSF, DOD, etc.)