Form DS-3091 THOMAS R. PICKERING FOREIGN AFFAIRS FELLOWSHIP PROGRAM

APPLICATION INSTRUCTIONS
The following descriptive information will assist you in completing your application.
1. Financial Need. Consideration will be given to qualified applicants who, in addition to outstanding academic
achievement and leadership skills, demonstrate financial need. Applicants should provide a copy of the most recent
Student Aid Report (SAR), which indicates your Estimated Family Contribution (EFC). If you have received Pell
grants, please attach copies of your award documents. If you cannot provide these documents, please state the
reason why on a separate sheet of paper headed "Financial Aid Statement."
2. Undergraduate Education/Course Work and Grades. Emphasis will be placed on the academic rigor of
undergraduate course work taken in six undergraduate subject areas: 1) English; 2) Mathematics/Quantitative
Courses; 3) Sciences; 4) Economics/Business or Management; 5) Government/Political Science; and 6) Foreign
Language Studies.
Emphasis is on performance in undergraduate course work and program of study.
Graduate Education. List all graduate schools to which you have applied.
3. College or Community Honors and Awards. Please list all honors and awards received during your
undergraduate education.
4. Extracurricular/Community/Volunteer and Leadership Activities. List the following: 1) Participation in
extracurricular/community/volunteer activities that relate to social causes and issues; and 2) leadership roles in those
activities, such as creating a program within your community or your college/university and/or serving as president,
leader, and/or spokesperson of such programs, organizations, or activities.
5. Personal Statement (maximum: two typed, double-spaced pages; 12-point type font; one-inch margins on all
sides. NO EXCEPTIONS TO THESE GUIDELINES.) Your personal statement is very important. It should be clearly
written and should help the reader to learn about your unique personal experiences and your background, interests,
and career goals. In writing your personal statement, you should address ALL of the following:
- Any disadvantages or obstacles you had to overcome to obtain your education (such as low-income background;
single-parent household; need to finance your own education by working full or part time; low GPA in high school;
etc.).
- Your cultural sensitivity (illustrated by interest in foreign language; exposure to other cultures; volunteer or paid work
experiences with people of various cultures or socioeconomic groups; tutoring or teaching experience; etc.).
- Your diverse interests and background (demonstrated by such activities as living, traveling, studying or performing
volunteer work outside the United States; internships with international organizations, Congress, or the Federal
government; work with the Peace Corps or AmeriCorps; etc.).
- Your interest, motivation, and commitment to a career in international relations and/or public service; and/or serving
the public in a domestic or international environment (interest in working within government, Foreign or Civil Service,
Congress, the United Nations, the World Bank, the Organization of American States,;etc.).
6. Two Letters of Recommendation. One letter should be from a community leader who knows you. One letter
should be from a university or faculty member who knows you. Letters of recommendation must be MAILED
DIRECTLY to Dr. Richard Hope at the address below.
Submit all materials to:
Dr. Richard O. Hope
Director, Foreign Affairs Fellowship Program
The Woodrow Wilson National Fellowship Foundation
P.O. Box 2437
Princeton, NJ 08543-2437
Courier Address:
5 Vaughn Drive, Suite 300, Princeton, NJ 08540-6313
http://www.woodrow.org
DS-3091
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Instruction Page 1 of 1

* OMB APPROVAL NO. 1405-0143
EXPIRES: xx-xx-xxxx
ESTIMATED BURDEN: 5 Hours

U.S. Department of State

THOMAS R. PICKERING FOREIGN AFFAIRS FELLOWSHIP PROGRAM
You must check one

Undergraduate

Graduate

Participation open ONLY to United States Citizens
Faxes will not be accepted - Original Application Form and Supporting Documents must be received by the application deadline.

Please read the attached Application Instruction Sheet carefully before completing this form.
The following application materials must be submitted BY YOU in one packet (see Application Instruction Sheet):
Application Form (use only this official form - photocopies accepted - form cannot be recreated)
Personal Statement (maximum two typed, double-spaced pages; 12-point type font; one-inch margins on all
sides. No Exceptions to these Guidelines.)
Complete Federal government forms SF-181 "Race and National Origin" and SF-256 "Self-Identification of
Handicap"
GRE Form (for Graduate) or SAT Form (for Undergraduate)
Certification of Citizenship. Notarized copy of: 1. birth certificate; 2. certificate of United States citizenship; or 3. United
States passport
Resume (2 page maximum)
The following application materials must be submitted by the appropriate institutions or individuals:
Two letters of recommendation. See Instruction Sheet
Official Academic Transcript(s): from all undergraduate institutions attended, including school awarding the
bachelor's degree (if applicable)
A copy of your most recent Student Aid Report (SAR), which indicates your Estimated Family Contribution (EFC). If
you cannot provide these documents, please state the reason why on a separate sheet of paper headed "Financial Aid
Statement"
1. Name (Last, First, Middle)
Indicate date valid until (mm-dd-yyyy)

2. Current Address
City

State

Zip Code

Day Telephone Number

Evening Telephone Number

E-Mail Address

3. Permanent Address (Final notification of application status will be mailed to the permanent address)
Residing with

Parent (s)

Spouse

Name(s)

Street
City

State

Zip Code

Day Telephone Number

Evening Telephone Number

E-Mail Address

* Public reporting burden for this collection of information is estimated to average 5 hours per response, including time required for searching existing data
sources, gathering the necessary data needed, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b),
persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on
the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, DC 20520.

DS-3091
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4. Financial Need - Sources of Funds for Current Academic Year
(Or Most Recent Academic Year of Undergraduate Education; indicate year)
Estimate Total Annual Cost of School Attendance
Self $

Parent $

Other $

$

Student Loans $

Need Based Scholarships/Grants $

Specify

Did you receive Pell grants as an undergraduate?

TOTAL $
Yes

No

If yes, how much? $
Please attach Pell grant document(s) to verify.

5. Education:
(a) Undergraduate Education (list all institutions, with the most recent listed first)
College/University

City/State

Major

Cum GPA

Dates Attended

Date or Expected Date of Graduation with Bachelor's Degree (mm-yyyy)
(b) Course Work and Grades - List all course work and grades in the following subjects:
English Courses:
1. Title
2. Title
3. Title

Grade
Grade
Grade

(Use additional sheet of paper if necessary for any courses)
Mathematics/Quantitative Courses:
1. Title
2. Title
3. Title

Grade
Grade
Grade

Science Courses:
1. Title
2. Title
3. Title

Grade
Grade
Grade

Economics/Business or Management Courses:
1. Title
2. Title
3. Title

Grade
Grade
Grade

Government/Political Science Courses:
1. Title
2. Title
3. Title

Grade
Grade
Grade

Foreign Language Courses:
1. Title
2. Title
3. Title

Grade
Grade
Grade

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5. Education (Graduates Only - please fill out items 5(c) and 5(d))
(c) Graduate Education:
If known, name of Graduate School you will attend in this fall:
(Attach admission letter and acceptance letter)
Expected program of study:
Expected graduation date:
Name of degree:
(Note: Applicants must receive their Master's Degree within two years.)
(d) Graduate Institutions to which you have applied - only U.S. institutions eligible:
(use additional sheets of paper if necessary.)
1.

Date Applied

2.

Date Applied

3.

Date Applied

4.

Date Applied

(mm-dd-yyyy)
(mm-dd-yyyy)
(mm-dd-yyyy)
(mm-dd-yyyy)

6. Language Proficiency

Level of Ability Key
1 = Elementary

Check the number to characterize your ability:

READING

LANGUAGE(S)
English

2 = Competent

3 = Native

4= Scholarly
SPEAKING

WRITING

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

7. List of College or Community Honors and Awards
1. Title

Year

2. Title

Year

3. Title

Year

4. Title

Year

5. Title

Year

6. Title

Year

7. Title

Year

8. Title

Year

9. Title

Year

10. Title

Year

11. Title

Year

12. Title

Year

13. Title

Year

14. Title

Year

15. Title

Year

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8. Extracurricular/Community/Volunteer and Leadership Activities
(Include volunteer and unpaid work experiences such as internships; describe any leadership roles in these activities.
Use additional sheets of paper if necessary - see Application Instruction Sheet)

9. Personal Statement - Please Use Blank Sheets of White Paper.
(Read the Application Instruction Sheet carefully regarding the personal statement.)
10. I Certify That All of the Information Entered on this Application is True and Complete
Date (mm-dd-yyyy)

Signature of Applicant

AUTHORIZATION TO RELEASE EDUCATION RECORDS: Under the Family Educational Rights and Privacy Act
of 1974, you must sign a release before your program files can be used in any future evaluation study of this program.
Any information in these files will remain confidential and only aggregate data on students will be released in study
reports. Consideration of your application is not contingent on your authorization to release education records and
your consent will have no bearing on the selection committee's decision.
I authorize the Woodrow Wilson National Fellowship Foundation to release information personally identifiable
to me from the files and records maintained in connection with this application for the U.S. Department of State
Thomas R. Pickering Foreign Affairs Fellowship Program. The information is to be released only to The Woodrow
Wilson National Fellowship Foundation and the U.S. Department of State.
This authorization is provided pursuant to and in accordance with the Family Educational Rights and Privacy
Act of 1974.
PRIVACY ACT STATEMENT
AUTHORITIES: Section 552a of Title 5 of U.S.C. This authorization is pursuant to and in accordance with
the Privacy Act of 1974.
PURPOSE: The principal purpose for requesting this information is to determine eligibility, qualifications, and
suitability of applicants for the Thomas R. Pickering Foreign Affairs Fellowship Program, and for Federal
Employment. It is also to obtain authorization from the candidate to allow the Woodrow Wilson National Fellowship
Foundation and the U.S. Department of State to share personally identifiable information from the files and records
maintained in connection with this application. The information collected on this form will be released only to the
Woodrow Wilson National Fellowship Foundation and the U.S. Department of State.
ROUTINE USES: The information collected is used solely for the purpose of determining the qualifications of
each applicant. This information may be shared between the Woodrow Wilson Fellowship Foundation, and U.S.
Department of State, for the purposes of administering the Thomas R. Pickering Foreign Affairs Fellowship, under
established guidelines.
DISCLOSURE: Although the application forms request both optional and mandatory data, it is in the
candidates best interest to answer all questions. Omission of an item means you might not receive full
consideration for a position for which this information is needed.
Signature of Applicant
DS-3091

Date (mm-dd-yyyy)
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