JACOB K. JAVITS FELLOWSHIP PROGRAM

FINAL PERFORMANCE REPORT

OMB No. 1840-0752

Expires: xx/xx/xx

Grant Number:

Institution Name:

Address:

City:

State:

Zip:

Program Coordinator:

Telephone Number:

Fax Number:

E-mail Address:

Fiscal Data

Please enter data for each budget period and the budget for the project period.

Budget 

Period 1 

FY XXXX

Budget 

Period 2 

FY XXXX

Budget 

Period 3 

FY XXXX

Budget 

Period 4 

FY XXXX

Total Budget for 

Project Period FY 

XXXX-XXXX

Federal Funds 

Awarded: $0

Federal Funds 

Expended: $0

Federal Funds 

Remaining: $0

Section I: Grantee Information

Total Number of Jacob K. Javits fellowships originally awarded 

to the grantee institution in FY XXXX:
JACOB K. JAVITS FELLOWSHIP PROGRAM

FINAL PERFORMANCE REPORT

OMB No. 1840-0752

Expires: xx/xx/xx

Fellow's Name:

Last name, First name

Fellow's Gender: Male: Female:

Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

Race:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White

Anthropology History

Archaeology Less Commonly Taught Languages

Area Studies Linguistics

Art History Music

Classics Non-American History

Communications and Media Philosophy

Comparative Literature Political Science

Creative Writing Psychology

Criminology Public Policy and Administration

Economics Religion

English Sociology

Ethnic and Cultural Studies Speech, Rhetoric and Debate

Folklore, Folk Life Studio Arts

Foreign Language Theater Arts

Geography TV, Film and Cinematography

Terminal Degree Sought:

Please enter the requested data for each individual Javits fellow. If you have more than one fellow, please 

copy this worksheet by right-clicking on the tab below that says "Sec 2" and selecting "Move or Copy." Then, 

check the box that says "Create a copy" and select "move to end." Then click "OK." Do this as many times as 

necessary to create a sheet for each fellow.

Section II: Individual Student Data

General Information

Program of Study

Fellow's Discipline (please select from the following approved fields of study):

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JACOB K. JAVITS FELLOWSHIP PROGRAM

FINAL PERFORMANCE REPORT

OMB No. 1840-0752

Expires: xx/xx/xx

What is the fellow's current education status?

Is enrolled but not yet advanced to Ph.D. candidacy

Has passed preliminary exams and advanced to Ph.D. candidacy

Has received Ph.D.

If fellow has received Ph.D., please specify the month and year of graduation:

Month: Year:

Has withdrawn from his/her academic program prior to graduation

Other (Please specify in comment box below)

Comments:

Research Assistant

Teaching Assistant

Other (please specify):

Not Applicable

Fellowship

Scholarship

Research Assistantship

Teaching Assistantship

Student Loans

Employment (full-time or part-time)

Other (please specify):

If the fellow was employed part-time while receiving Javits fellowship funding, please indicate the type 

of employment:

How does the fellow plan to finance his/her remaining graduate study if the Javits fellowship funding 

ended before the date of graduation?

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JACOB K. JAVITS FELLOWSHIP PROGRAM

FINAL PERFORMANCE REPORT

OMB No. 1840-0752

Expires: xx/xx/xx

Yes

No

Not yet graduated

Graduated; not yet found employment

Unknown

Where did the fellow find employment after graduation (check all that apply)?

Institution of higher education

Other educational institution

Federal, state or local government

Community-based/Non-profit organization

Research organization

Private Sector

International employment

Continued post-graduate study

Other (please specify):

Not Applicable (not yet graduated; not yet found employment)

Unknown

Start Date of Graduate Study:

Start Date of Javits Fellowship:

End Date of Javits Fellowship:

Total Years of Javits Fellowship Funding:

Total Years of Graduate Study:

Budget Period 1 (FY XXXX):

Budget Period 2 (FY XXXX):

Budget Period 3 (FY XXXX):

Budget Period 4 (FY XXXX):

Total for Project Period:

Is the fellow's post-graduate employment in a field that relates directly to his/her academic field of 

study, as funded by the Javits fellowship?

Fellow's Stipend and Financial Need

Financial need is determined each year on the basis of the requirements for need analysis prescribed by Title 

IV, Part F of the Higher Education Act of 1965, as amended. Please consult your institution's financial aid 

office for information or questions regarding the determination of financial need.

Please report the fellow's stipend, as determined by his/her financial need, for each budget period of the grant 

(Note: please indicate the stipend amount received by the student in that budget period; this may differ from 

the amount of stipend funding actually awarded by the Javits Fellowship Program to the institution for that 

fellow during the budget period, due to carry over of unused funds):

$0

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JACOB K. JAVITS FELLOWSHIP PROGRAM

FINAL PERFORMANCE REPORT

OMB No. 1840-0752

Expires: xx/xx/xx

Total Federal Funding

Budget Period Stipend

1 (FY XXXX)

2 (FY XXXX)

3 (FY XXXX)

4 (FY XXXX)

TOTAL: $0

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such 

collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 

XX minutes/hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining 

the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is 

mandatory (citing authority)/required to obtain or retain benefit (citing authority) and voluntary. Send comments regarding the 

burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. 

Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email ICDocketMgr@ed.gov and reference the 

OMB Control Number XXXX-XXXX. Note: Please do not return the completed XXXX (cite form or other applicable reporting 

mechanism) application to this address.

DISCLOSURE OF BURDEN STATEMENT

$0 $0

$0

Total

$0

Please indicate the total amount of Javits fellowship funding received by your institution in each budget period 

for this fellow. In the "Stipend" column, please do not include funds carried over from previous years. Include 

only the funds awarded to you in that fiscal year/budget period.

$0

$0

Institutional Payment

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