Center for Undergraduate Research and Fellowships

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First Name:

Middle Name:

Last Name:

Penn ID Number:

Place of Birth:

Date of Birth (mm/dd/yyyy):

Citizenship

Contact Information

Permanent Address

Address 1:

Address 2:

City:

State:

Zip Code:

Home Phone Number:

Email:

Penn Address

Address 1:

Address 2:

City:

State:

Zip Code:

Local Phone Number:

Proposed Course of Study

List two British institutions you wish to attend and to which you intend to apply:

1st choice:

2nd choice:

Academic degree title (e.g. Mphil in x) you would receive from the institutions listed above:

1st choice institution:

Length of Program (years)

2nd choice institution:

Length of Program (years)

Have you ever visited the United Kingdom, and, if so, when and why?

What other travelling have you done outside the US?

Secondary Education

Name of secondary/high school:

Location of school:

Dates attended (mm/yyyy):

Prizes and distinctions:

University Education

School (select all that apply using CTRL+click):

Current overall GPA:

Primary Major:

Secondary Major(if applicable):

Date of Matriculation at the University of Pennsylvania:

Graduation Year

Other colleges or universities attended, including dates and degrees if any:

Prizes and distinctions:

Extracurricular activities and offices held:

Career and Future Plans

Outline your work and volunteer experiences. How did you choose these? How have they supported your career aspirations? (250 words)

What do you hope to accomplish in your professional field? (2-3 sentences)

What sorts of activities do you expect to take part in outside your professional field? (2-3 sentences)

What are your plans for September in the event that you do not secure a Thouron award? (2-3 sentences)

What other fellowship/scholarships have you applied for? Why did you choose those? If only the Thouron, why the Thouron Award?

Other Interests:

What interesting fact can you tell us about yourself that isn’t covered elsewhere in this application.

References

Three persons from whom you have requested a letter of reference:

First Name:

Last Name:

Position/Title:

Department and School or Business:

Email address:

First Name:

Last Name:

Position/Title:

Department and School or Business:

Email address:

First Name:

Last Name:

Position/Title:

Department and School or Business:

Email address:

Upload a high quality digital photograph of yourself, one that would be appropriate for a passport, in .jpg format. The file should be named [your pennkey_photo], and cannot be any larger than 10 mb in size.

In one .pdf, include your personal statement, resume, and a scanned copy of your transcript from the Registrar’s office. The file should be named [your pennkey], and cannot be any larger than 10 mb in size.