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Search
Stein Fellowship Application
Step
1
of
5
20%
Applicant Information
Name
*
First
Last
Email
*
Preferred Phone Number
*
Home Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Work Information
Company
*
Current Title
*
Time at Company
*
Immediate Supervisor
*
Company CEO
*
Company Phone Number
*
Company Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Education
Undergraduate
College/University
Major/Concentration
Degree
Date Awarded
MM slash DD slash YYYY
Graduate
College/University
Major/Concentration
Degree
Date Awarded
MM slash DD slash YYYY
Volunteer Activities
Please list your most significant volunteer experiences. (Note: your resume will provide you the opportunity to describe the activities listed.)
Organization
Dates
Project/Activity
Organization
Dates
Project/Activity
Professional Organizations
Please list your most significant professional memberships and extracurricular activity. (Note: your resume will provide you the opportunity to describe the activities listed.)
Organization
Dates
Office/Position Held
Organization
Dates
Office/Position Held
Uploads
Please attach your resume, references and personal statement.
Resume
*
Accepted file types: doc, docx, pdf, Max. file size: 300 MB.
Letter of recommendation from employer
*
Accepted file types: doc, docx, pdf, Max. file size: 300 MB.
Submit a letter of recommendation from current (previous employer) employer on employer’s letterhead, including referral contact information (if employed less than 6 months.)
Letter of personal recommendation
*
Accepted file types: doc, docx, pdf, Max. file size: 300 MB.
Submit a letter of personal recommendation from a co-worker or previous manager (non-family) with personal contact information for referral.
Personal Statement Video
*
Accepted file types: mp4, mov, wmv, flv, webm, Max. file size: 300 MB.
Please record and upload a video, two minutes or less, with your answer to the following question:
Humans created poverty. How can we as humans solve for poverty in Northeast Florida?
Certification & Submission
Certification 1
*
I hereby affirm that the information provided on this application and on my resume is up-to-date, true and complete.
Certification 2
*
I hereby authorize United Way of Northeast Florida to contact the persons, schools, employers and other organizations named in this application and on my resume to confirm the information which I have provided and obtain additional information needed.
Certification 3
*
My immediate supervisor is aware of my application and understands that the time commitment will extend into business hours (on average two hours per week).
Certification 4
*
I understand and am fully aware of the time commitment needed to make this a successful fellowship for myself, my mentor and my mentee.
Signature
*