Robert Novak Fellowships

2012 Robert Novak Journalism Fellowship Application

Please fill out the form below and click submit. Note: Once you start completing the form it must be finished and sent as you cannot save or print the information for later. A printer-friendly version of the form is available here if you would like to review it before filling out the application online.

The online application must be submitted by February 21, 2012. All application materials must be postmarked by February 21, 2012. We recommend you send the follow-up material via Certified mail, FedEx or UPS for proof of receipt.

Personal Information

Name

Last : *

First : *

Middle : *

Social Security Number : *

Date of Birth :

US Citizen? (Only open to US Citizens) : *

Home Address

Address : *

City : *

State : *

Zip : *

Employment Information

Employer :

Present Position :

Annual Salary :

Additional Income :

Office Address

Address :

City :

State :

Zip :

Contact Information

Home Phone :

Office Phone :

Cell Phone :

Email Address : *

Title or Brief Description of Fellowship Proposal

Education

Name and Location of High School :

Year of Graduation :

College or University :

Degree and Year Awarded :

College or University :

Degree and Year Awarded :

Previous Awards and Fellowships

Employment History

Employer :

Position :

Immediate Supervisor :

Dates of Employment :

Articles or Books Published

References

Reference 1

Name :

Company :

Address :

Phone :

Reference 2

Name :

Company :

Address :

Phone :

Reference 3

Name :

Company :

Address :

Phone :

I am interested in a :

How did you learn about this program? :

Have you ever been convicted of a crime other than a minor traffic offense? :

If yes, please explain: :

Supplementary Information

To be considered for a fellowship, you MUST submit the following materials (postmarked by February 21st, 2012). Please send to: The Phillips Foundation One Massachusetts Ave, NW, Suite 620 Washington, DC 20001 Attn: John Farley We recommend sending via Certified Mail, FedEx or UPS for proof of receipt.

Fellowship Proposal - A single-spaced, typed proposal (not to exceed three pages) describing how you would use the Robert Novak Journalism Fellowship to undertake and complete a journalism project supportive of American culture and a free society. Provide a brief summary of the four installments which would be due over the course of the year. Also include a statement explaining why you are applying for this fellowship. Only one proposal will be accepted from each candidate :

Samples of Your Work - Please enclose five sets of three relevant samples of your work which demonstrates your journalistic abilities and your support of the Foundation's mission to advance constitutional principles, a democratic society, and a vibrant economic system based upon private enterprise :

Curriculum Vitae - A typed resume including details of your work history, educational background, and your commitment to journalism. :

Budget Statement - A detailed budget statement listing anticipated fellowship costs directly related to the fellowship, such as travel and research materials. Also indicate what funds, if any, would be available to you during the fellowship year from other sources. :

References - Please have three individuals familiar with your work and your fellowship proposal submit a letter of recommendation directly to The Phillips Foundation, postmarked by February 21, 2012. List the names and addresses of your references above. :