Weinstein JAMS International

Fellowship Program
Application Form

Name: _____________________________________________________________

Current Mailing Address: _______________________________________________

Permanent Mailing Address: ____________________________________________

Primary E-mail Address:________________________________________________

Alternate E-mail Address(es): ___________________________________________

Office/Work Phone: ___________________________________________________

Mobile Phone: ________________________________________________________

Date of Birth:_________________________________________________________

Nationality/Country of Origin: ___________________________________________

Current Country of Residence: ___________________________________________

Current Occupation: ___________________________________________________

Current Employer: ___________________________________________________

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Organizations or institutions with which you are currently affiliated in your home
country and the nature of your affiliation (eg. member, officer, director, faculty):

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Educational Background (attach additional pages if necessary):

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Dispute Resolution Training and Experience (attach additional pages if necessary):

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Describe Fellowship proposal in detail, including a description of the following

(attach additional pages if necessary):

1. What you hope to accomplish during your time in the U.S.

2. How you intend to achieve your Fellowship goals
3. How you will implement or advance your dispute resolution objectives upon your
return home
4. Why this is important or necessary for your country

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Anticipated ADR-focused activity while in the U.S., including the names of individuals,
organizations or institutions with which you are or intend to be affiliated during your
time in the U.S.:

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Anticipated ADR-related activity upon return to home country:

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Amount of funding requested and proposed budget (may include anticipated travel
expenses, housing expenses, tuition and course registration fees, and other costs
reasonably necessary to accomplish Fellowship objectives):

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Other sources of funding available, applied for, or awarded, if any:

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Additional non-monetary resources or support sought from JAMS Foundation:

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Proposed U.S. location(s) for Fellowship activity: ____________________________
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Proposed dates and duration of Fellowship project (note: in addition to other

proposed activities, all Fellows are required to participate in a week-long gathering
of Fellows in the San Francisco Bay Area in September 2017):

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Current visa status for entry into U.S.: ____________________________________

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Previous Visits to U.S. – date(s), location(s), duration:________________________

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Please attach your Curriculum Vitae and two letters of reference or recommendation
in support of your application.

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