IWU Fund for Human
Rights, Environmental
Sustainability and Social
Justice Application Form
Personal Information
Name (First and Last):
Student ID:
Email (@iwu.edu):
@iwu.edu
Local Phone:
Local Address (Hall, House, or Off-Campus):
Academic Information
Class year:
First year
Sophomore
Junior
Senior
Major 1:
Major 2:
Minor 1:
Minor 2:
Current Overall GPA:
Program Information
Name of internship:
Name of sponsoring organization:
Address:
Phone number:
Name of contact person who will be your supervisor:
Address and phone number of supervisor if different from above:
Name of Reference #1
Affiliation
Email Address
Phone Number
_
Name of Reference #2
Affiliation
Email Address
Phone Number
_
1 | P a g e Narrative Essay in Paragraph Form
Please respond to the following questions in no more than 750 words total.
Part A (for all applicants)
1. Describe the nature of your proposed internship, its sponsorship and how the organization housing the
internship supports human rights, environmental sustainability, or human rights.
2. Explain how participating in this internship will further your own understanding of human rights,
environmental sustainability, and/or social justice.
3. Describe the courses and other experiences that have prepared you to take optimal advantage of this
internship opportunity.
4. Discuss how participating in this internship will affect your future career plans with regard to human
rights, environmental sustainability, and/or social justice.
5. If relevant, include additional information that the Fund for Human Rights, Environmental
Sustainability, and Social Justice Steering Committee should know about your commitment to human
rights, environmental sustainability, and/or social justice.
Part B (Only if you have already been formally accepted or have formally applied to a
designated internship)
1. Include a copy of the personal information, statement of interest, and supporting information sent to the
organization as part of one’s application for the internship.
2. Describe external forms of support or other funds one is soliciting or may receive apart from what one is
requesting from this fund as a result of having successfully obtained the internship.
3. Submit a budget including the amount of funds you are requesting and how those funds will be
specifically used (maximum amount: $5,000.00 in any one calendar year).
Part C (Only if you wish to create an internship or project that does not currently exist)
Please consult with Elyse Nelson Winger ([email protected]) Deborah Halperin ([email protected]), William
Munro ([email protected]), or Teddy Amoloza ([email protected]).
Confirmation of Conditions of the Grant and Authorization for Release of Academic and
Personal Information
In applying for this grant, I agree to the following stipulations:
1. I certify that all of the information reported in my application materials for the IWU Fund for Human
Rights, Environmental Sustainability, and Social Justice Internship Program award is true and complete
to the best of my knowledge. If there are any changes to my plans after I submit this application, I
understand that I must notify the Director of the Center for Human Rights and Social Justice
immediately.
2 | P a g e 2. If I am selected as an internship award recipient, I authorize the release of my personal information for
the purposes of publicity and recognition. I also commit to share my internship experience with the
IWU community within on semester of returning to campus.
My signature below confirms my understanding and acceptance of the above stipulations.
Name (print)
Signature
Date
Please e-mail the completed application form, a current resumé, and the narrative 750 word statement addressing
each of the relevant questions to [email protected]. Please have letters of support sent directly to the same
address. All documentation must be received no later than March 1, 2017.
3 | P a g e