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**

**JEFFERSON FELLOWSHIPS APPLICATION\
INSTRUCTIONS\
**

**[IMPORTANT:]{.underline}** Your application is not complete until
**[all]{.underline}** of the following are submitted:

-   The entire application form (pages 1 & 2). If you need more space,
    you may attach additional pages.

-   A letter from you outlining issues of interest, a brief description
    of your organization, and what you expect to accomplish if an award
    is granted. Please suggest topics you propose to address in your
    paper and presentation at the Center (Maximum 3 pages,
    double-spaced, please).

-   Names, addresses, phone/fax numbers and e-mail, if available, of
    three people who may be contacted by the Center as references. Two
    of these references should be people outside your news organization.

-   A letter of recommendation on official letterhead, with original
    signature, from your supervisor describing your suitability for the
    Fellowship and the benefit the organization hopes to derive from
    your participation in the program.

-   The "Employer's Statement of Support" form.

**\*Note:** Samples of your work are not required. If you wish to
include samples, we prefer web links to articles (when possible) rather
than hard copies.

**Return by Wednesday, June 4, 2008 via:**

**E-MAIL:** <jefferson@eastwestcenter.org>

OR

**FAX:** (808) 944-7600

OR

**POST:** Jefferson Fellowships Program, East-West Seminars\
East-West Center, 1601 East-West Road, Honolulu, Hawaii, 96848-1601, USA

**For information or clarification call:** (808) 944-7682

**[PLEASE NOTE, for fax and e-mail submissions:]{.underline}** Indicate
**"Jefferson Fellowships Application"** in the subject heading. We will
confirm receipt of the application within 5 working days. If you do not
hear back from us, please follow up.

● Applications must be received at the East-West Center by the
application deadline in order to be considered.

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**\
JEFFERSON FELLOWSHIPS APPLICATION**

**Please type or print legibly. Use additional pages if necessary.**

  ---------------------- ------------------------------------------------
  Name of applicant      
  *(Mr./Ms./Dr.):*       

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

  --------------------------- ----------------- -------------- --------------
  ***[(Exactly as it appears  *Family Name*     *Given Name*   *Middle Name*
  in                                                           
  passport)]{.underline}***                                    

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

  -------------------------- --------------------------------------------
  Country of legal permanent 
  residence:                 

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

<table style="width:100%;">
<colgroup>
<col style="width: 13%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 10%" />
<col style="width: 9%" />
<col style="width: 8%" />
<col style="width: 6%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 6%" />
<col style="width: 10%" />
<col style="width: 0%" />
<col style="width: 10%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="3">Passport Number:</td>
<td colspan="2"></td>
<td colspan="5">Country of Issue:</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="6"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">Expiration Date:</td>
<td colspan="3"></td>
<td colspan="3">Place of Issue:</td>
<td colspan="6"></td>
<td>Male:</td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="6"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">Date of Birth:</td>
<td colspan="3"></td>
<td colspan="3">Place of Birth:</td>
<td colspan="6"></td>
<td>Female:</td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4"><em>Month / Day / Year</em></td>
<td colspan="2"></td>
<td colspan="9"><h1 id="city-country"> City / Country</h1></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="12"></td>
</tr>
<tr class="even">
<td colspan="4">Current Position/Title:</td>
<td colspan="12"></td>
</tr>
<tr class="odd">
<td colspan="4">Name of News Organization:</td>
<td colspan="12"></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="12"></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="12"><em>Street Number or Post Office Box</em></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="2"><em>City</em></td>
<td colspan="5"><em>State</em></td>
<td colspan="2"><em>Zip</em></td>
<td colspan="3"><em>Country</em></td>
</tr>
<tr class="odd">
<td colspan="4">Office Phone Number:</td>
<td colspan="5"></td>
<td colspan="3">Office Fax:</td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="4">Office E-mail address:</td>
<td colspan="12"></td>
</tr>
<tr class="odd">
<td colspan="4">Home Address:</td>
<td colspan="12"></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="12"><em>Street Number or Post Office Box</em></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="2"><em>City</em></td>
<td colspan="5"><em>State</em></td>
<td colspan="2"><em>Zip</em></td>
<td colspan="3"><em>Country</em></td>
</tr>
<tr class="even">
<td colspan="4">Home Phone Number:</td>
<td colspan="5"></td>
<td colspan="3">Home Fax:</td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="4">Home E-mail address:</td>
<td colspan="12"></td>
</tr>
</tbody>
</table>

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\*Note:** We will communicate with you via e-mail or your office fax,
unless you indicate otherwise.

**Post-Secondary Education**

  ----------------------- ------------------ ------------- ---------------
  Institution attended    Major Subject      Dates         Degree

                                                           

                                                           

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

**Positions Previously Held** (last ten years)

  ---------------------- --------------------------------- ---------------
  Position Title         Organization                      Dates

                                                           

                                                           

                                                           

                                                           

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

Memberships and Positions in Professional Associations; Professional and
Academic Honors

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

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

**Travel Outside Home Country** (please list countries, year and purpose
of travel)

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

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

**Language Ability**

  ------------------- -- ----------------------- -- -----------------------
                         Speaking Proficiency       Reading Proficiency

  Language               (fair/good/excellent)      (fair/good/excellent)

                                                    

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

**Have you previously participated in an East-West center program(s)? If
so, please list name(s) of program(s) and year(s).**

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

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> ![](media/image1.png){width="1.7027777777777777in"
> height="0.6715277777777777in"}

**JEFFERSON FELLOWSHIPS APPLICATION**

## Employer\'s Statement of Support

Financial support is not required, but employers are encouraged to
consider cost sharing as a demonstration of commitment to the goals of
the program. Completion of this form is required regardless of your
ability to provide financial support to the applicant. Please note that
applicant or employee will be responsible for all costs related to
obtaining visas for the program.

**Name of applicant:**

(Mr./Ms./Dr.) Family Name Given Name Middle Name

If the above applicant is selected for the Jefferson Fellowship, our
organization will provide the following support (check all that apply):

Air transportation:

Full trip, [or]{.underline}

Cost share up to a maximum amount of US\$ .

Per diem in Honolulu at \$30.00 per day.

Per diem during the travel period of US\$ per day.

Housing at EWC guesthouse at \$35.00 (studio) to \$48.00 (with kitchen)
per day.

Other (to be discussed with the East-West Center).

Employer\'s signature Date:

Name:

Position:

Organization:

Telephone: Fax: E-mail: