Segf Graduate Student Fellowship Application Form
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1
2FOR SEG OFFICE USE ONLY
Graduate Student Fellowship pplication No. GSF 16-_____
SEGF Graduate Student Fellowship Application Form – 2016
Part 2 of 3
This form is in a “fillable” interactive format meaning it can be populated electronically,
saved and emailed as a pdf. attachment to: .
Please see Part 1, Elements of the Program and Instructions, for complete instructions,
and Part 3, Appraisal of Applicant (Reference 1) Form, for Ref 1
and Appraisal of Applicant (Reference 2) Form for Ref 2.
For further guidance, please refer to “Suggestions for Writing a Successful SEGF GSF Application”
SEG Student
Membership
Name of Applicant _______________________________________ Member No._________________Expires 12/31/______
Nationality: ________________________________ Graduate School/University Country: ___________________________
Complete Mailing Address:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
City___________________________ State _________________ Postal Code _____________ Country ________________
Phone ______________________________________________ Fax _____________________________________________
E-mail _______________________________________________________________________________________________
EDUCATION, starting with most recent
University (1) and Location ______________________________________________________________________________
Years: From__________________ To ________________ Degree__________________________ Year______________
(Month and Year)
(Month and Year)
University (2) and Location ______________________________________________________________________________
Years: From__________________ To ________________ Degree__________________________ Year______________
(Month and Year)
(Month and Year)
University (3) and Location ______________________________________________________________________________
Years: From__________________ To ________________ Degree__________________________ Year______________
(Month and Year)
(Month and Year)
Have you ever received any financial assistance (student research grant,
conference grant, travel assistance or other) from either the SEGF or the SEG? Yes _____ No_____
If Yes, please provide details (award(s), year(s) and amount(s):___________________________________________________
____________________________________________________________________________________________________
********************
For the following questions, confine your response to the space provided.
What are your major areas of interest in economic geology?
9 2016
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