## JA **COB 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:

### JA**COB K. JA VITS FELLOWSHIP PROGRA**  **M FINA**  **L PERFORMA NCE 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 Wh ite

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 W riting 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** **):**

1 of 4

### JA**COB K. JA VITS FELLOWSHIP PROGRA**  **M FINA**  **L PERFORMA NCE 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 y** **ear 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 employ ed part-time while receiving Javits fellowship funding, please indicate the ty**  **pe of employ**  **ment:**

**How does the fellow plan to finance his/her remaining graduate study if the Javits fellowship funding**  **ended before the date of graduation?**

2 of 4

### JA**COB K. JA VITS FELLOWSHIP PROGRA**  **M FINA**  **L PERFORMA NCE 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 employ ment 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 employ**  **ment in a field that relates directly to his/her academic field of**  **study , as funded by** 

**the Javits fellow ship?** 

**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**

3 of 4

### JA**COB K. JA VITS FELLOWSHIP PROGRA**  **M FINA**  **L PERFORMA NCE 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) **TOTA L:**  $0

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection display s 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 Pay ment** 

4 of 4