Form 1840-0752 Javits FPR Form and Instructions

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Overview

Sec 1
Sec 2

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Sheet 1: Sec 1

Section I: Grantee Information
Grant Number:
Institution Name:
Address:
City:
State:
Zip:
Program Coordinator:
Telephone Number:
Fax Number:
E-mail Address:
Total Number of Jacob K. Javits fellowships originally awarded to the grantee institution in FY XXXX:
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

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Sheet 2: Sec 2

Section II: Individual Student Data
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.
General Information
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
Program of Study
Fellow's Discipline (please select from the following approved fields of study):
	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:
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	Has withdrawn from his/her academic program prior to graduation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:
If the fellow was employed part-time while receiving Javits fellowship funding, please indicate the type of employment:
	Research Assistant
	Teaching Assistant
	Other (please specify):
	Not Applicable
How does the fellow plan to finance his/her remaining graduate study if the Javits fellowship funding ended before the date of graduation?
	Fellowship
	Scholarship
	Research Assistantship
	Teaching Assistantship
	Student Loans
	Employment (full-time or part-time)
	Other (please specify):
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?
	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:
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):
Budget Period 1 (FY XXXX):
Budget Period 2 (FY XXXX):
Budget Period 3 (FY XXXX):
Budget Period 4 (FY XXXX):
Total for Project Period:			$0
Total Federal Funding
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.
	Budget Period	Stipend	Institutional Payment		Total
	1 (FY XXXX)				$0
	2 (FY XXXX)				$0
	3 (FY XXXX)				$0
	4 (FY XXXX)				$0
	TOTAL:	$0	$0		$0
	DISCLOSURE OF BURDEN STATEMENT
	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 [email protected] 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.