2251 SW Jefferson Way, SEC 206  · Web view2251 SW Jefferson Way, SEC 206. Corvallis, Oregon 97331 (541) 737-3172. 2251 SW Jefferson Way, SEC 206. Corvallis, Oregon 97331 (541) 737-3172.

2251 SW Jefferson Way, SEC 206Corvallis, Oregon 97331(541) 737-3172

Sustainability Fellowship Program Research Fellow Application

2016-2017

Application Date [Enter Here]Student Name [Enter Here]Major [Enter Here]Cumulative GPA [Enter Here]Undergraduate or Graduate [Enter Here]Expected Date of Graduation [Enter Here]Mailing Address [Enter Here]Phone [Enter Here]Email [Enter Here]

Name of Faculty Mentor [Enter Here]Title [Enter Here]Department [Enter Here]Email Address [Enter Here]Phone Number [Enter Here]

Have you been awarded an SSI grant before? [Enter Here]

If yes, Grant Title, Award Amount & Date [Enter Here]

Research Project Title [Enter Here]Work Hours (5-15 per week) [Enter Here]

Transformative Learning * Intentional Engagement * Conscious CommunityAuthentic Leadership * Social Justice

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Statement of Need and Sustainability OutcomesSummarize the need for this research, including the sustainability outcomes it will achieve for OSU or the Corvallis community. Please be sure to address the project’s impact on each of the three pillars of sustainability (environmental, social, and economic), as appropriate. What impact will the project/results have for the general student body? (Limit one page)

Research Project Description Briefly describe the research project including methodologies, hypotheses or objectives, and the roles of the student researcher and faculty mentor. What are the expected outcomes from your research and how will you achieve these outcomes? How will your results be shared and/or implemented? (Limit two pages, written for a general audience, avoiding jargon and unexplained acronyms)

Learning OutcomesHow will this work support your academic, personal and professional goals? Include a brief summary of why you’re qualified to carry out this research and any relevant experience you have (previous research, volunteer work, employment, courses, etc.).Please list the leadership competencies, transferable professional skills, and scholarly experiences you hope to gain through supervision, mentorship, networking, and professional development. What are your expected Learning Outcomes and how will you achieve these outcomes? Speak specifically to the knowledge and skills you hope to gain in the areas of:

o Holistic Systems Thinkingo Sustainability Knowledge Awareness & Integration Skillso Social Justiceo Sense of Placeo Change Agent Skillso Practical Competence

(See Sustainability Learning Competencies)

Supervisor Qualifications Please briefly explain your mentoring philosophy and your qualifications to serve as a supervisor and mentor to a student Sustainability Fellow in this position. (Limit one page)

Required Attachments:

Form A: Regulatory Compliance verificationForm B: Sustainability Fellowship Work Plan Draft. If awarded, the Work Plan should be finalized with the student and submitted to SSI by Sept. 30, 2016.Student’s résumé

Transformative Learning * Intentional Engagement * Conscious Community *Authentic Leadership * Social Justice

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Student’s transcript (Unofficial transcript acceptable)

By signing below, I agree that the above information is complete and accurate to the best of my knowledge. I give Oregon State University permission to use my name, proposal, final report, and/or excerpts of it for the SSI website and/or assessment reports for the sole purpose of sharing information about student research and campus sustainability initiatives.* If there is a valid reason for not wanting this research documented on the SSI web site, attach a brief explanation (200 word limit).

Student’s Signature Date

By signing below, I agree that the above information is complete and accurate to the best of my knowledge. I will serve as supervisor for this position should funds be awarded by SSI.

Faculty Mentor’s Signature Date

By signing below, I agree that I have read this proposal and support the research activities outlined above.

Department Chair’s Signature Date

Transformative Learning * Intentional Engagement * Conscious Community *Authentic Leadership * Social Justice

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