hTheRev.Dr.MartinLutherKing,Jr.GraduateFellowship2019-2020Application

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Dr. Martin Luther King, Jr. Graduate Fellowship 2019-2020 Application (Due Date: June 14, 2019)

Personal & Academic Information Today’s Date: ____/____/____ NU ID Number: ________________ Last Name: __________________ First Name: ___________________ Middle: _______ E-mail Address: ____________________________@____________________________ Mailing Address: _________________________________________________________ Country: ___________________ Male: ____ Female: ____ Phone Number: ______________________

Select your College ¨ D’Amore-McKimm School of Business ¨ Arts, Media and Design ¨ Computer and Information Sciences ¨ Engineering ¨ Bouve Health Sciences ¨ Science ¨ Social Sciences and Humanities ¨ College of Professional Studies Are you being referred by your department: ¨ Yes ¨ No Graduate Program: ________________________ Planned Start Date : ____/____/____ (Acceptance into a graduate program required for MLK Fellowship acceptance) Undergraduate Institution(s): _______________________________________________ Undergraduate Major: _______________ Overall GPA*: ___________ Degree Earned: ______________________ Graduation Date : ____/____/____ * Please submit transcripts from all institutions attended Note: Doctoral, Executive MBA, Law School, International and online candidates are not eligible for the Dr. Martin Luther King, Jr. Graduate Fellowship.

OFFICEUSEONLY

DateReceived:____/____/____ Date Letter Sent: ____/____/____

hTheRev.Dr.MartinLutherKing,Jr.GraduateFellowship2019-2020Application

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Last Name: __________________ First Name: ___________________ Middle: _________

List Academic Honors and Awards

• • •

Leadership Roles and Activities

Co-Curricular Activities (within major): Other extracurricular activities: Community Activities: Other Information (i.e. experiences, other awards, etc.)

hTheRev.Dr.MartinLutherKing,Jr.GraduateFellowship2019-2020Application

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Last Name: __________________ First Name: ___________________ Middle: __________

Personal Recommendation First Name: __________________________________________________________ Last Name: __________________________________________________________ Title: __________________________________________________________ E-mail: _________________________@_______________________________ Phone: __________________________

Personal Recommendation First Name: __________________________________________________________ Last Name: __________________________________________________________ Title: __________________________________________________________ E-mail: _________________________@_______________________________ Phone: __________________________

Personal Recommendation

First Name: __________________________________________________________ Last Name: __________________________________________________________ Title: __________________________________________________________ E-mail: _________________________@_______________________________ Phone: __________________________ Three personal recommendations may be emailed to r.obryant@neu.edu. If recommenders prefer, a sealed copy may be mailed to the John D. O’Bryant African American Institute by June 7, 2019. * Recommendations – I acknowledge that my application will not be complete until my letters of recommendation have been received at the John D. O’Bryant African American Institute.

hTheRev.Dr.MartinLutherKing,Jr.GraduateFellowship2019-2020Application

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Last Name: __________________ First Name: ___________________ Middle: _________

Personal Statement

Please describe your personal qualification for the MLK Fellowship. Your application will be evaluated based on how you exemplify the criteria outlined on the MLK Fellowship website (http://www.northeastern.edu/aai/mlk-fellowship/). (Use additional pages if needed and include your last name, first name and date at the top of each page): Signature: ___________________________________________ Date: _________ Last Name: __________________ First Name: ___________________ Middle: __________

hTheRev.Dr.MartinLutherKing,Jr.GraduateFellowship2019-2020Application

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The Dr. Martin Luther King, Jr. Graduate Fellowship

2019-2020 Application Application Checklist:

¨ Apply to and be accepted into a Northeastern University graduate program* ¨ Apply for financial aid through FAFSA (https://fafsa.ed.gov/) and the

University’s Office of Financial Aid (www.northeastern.edu/financialaid/). ¨ Complete and submit an official Dr. Martin Luther King, Jr., Graduate

Fellowship Application along with an official undergraduate transcript. ¨ Complete and submit a personal statement. ¨ Have three personal reference letters mailed to the John D. O’Bryant African

American Institute. ¨ Attend a personal interview.

* We only accept applications from an approved Undergraduate University, full-time Master's degree program and references should come from an employer, university administrator or university professor. Please return your neatly prepared application, transcripts and a copy of your resume by Due Date: June 14, 2020 by fax, scanned email or postal mail: Fax#: (866)617-7616 Email: Dr. Richard L. O’Bryant – r.obryant@neu.edu

(617)373-3143 Postal: The Dr. Martin Luther King, Jr. Graduate Fellowship

The John D. O’Bryant African American Institute NORTHEASTERN UNIVERSITY 360 Huntington Avenue Boston, Massachusetts 02115