6/12/2018 PhD Works Summer 2018 Application

https://docs.google.com/forms/d/1i-1GmNC1wmEIGmSuhpPiHuOFNH9VK1X75Pj6X0AyFv0/edit 1/5

PhD Works Summer 2018 ApplicationYour email address (lyl.tomlinson@stonybrook.edu) will be recorded when you submit this form. Notlyl.tomlinson? Sign out* Required

Summer 2018 Application

Please complete the information below in order to apply for the Summer 2018 academic cycle of the PhD Works award program. At the end of this application, you will be asked to upload three PDF files: (a) a CV, (b) your short answer document, and (c) a proposed budget. Note: Activities that directly support students' thesis activities are unlikely to be funded (i.e. conference registration/travel to present thesis or dissertation research). For details on what is required, review the application website at www.stonybrook.edu/grad/professional-development/phd-works which includes a preview of the application questions requested in this Google form. PLEASE BE AWARE THAT YOU WILL NOT BE ABLE TO SAVE YOUR PROGRESS, SO PLEASE PREPARE ALL OF YOUR ANSWERS AND UPLOADABLE FILES IN ADVANCE. If you have any questions on the application, contact us at Lyl.Tomlinson@stonybrook.edu

1. First Name *

2. Last Name *

3. SBU Student ID Number *

6/12/2018 PhD Works Summer 2018 Application

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4. Institutional E-mail Address *

5. Preferred E-mail Address *

6. Preferred Phone Number *

7. SBU Graduate Program *

8. What is your G level as of Spring 2018? *

Mark only one oval.

G1

G2

G3

G4

G5

Other:

9. What is your expected graduation date? *(Month and Year)

Demographics

PhD Works Commitment to Diversifying the ProfessionalWorkforce

PhD Works aims to assist SBU PhD students prepare for careers within the professional workforce (broadly defined). An additional goal of the program is to diversify the future professional workforce by fostering the development of PhD students from underrepresented groups or people who can demonstrate they have overcome a disadvantage or impediment to success in higher education. Students whose participation in PhD Works would advance this goal, either through experience or demonstrated commitment, are strongly encouraged to apply and will qualify for limited professional development funds of up to $750.

6/12/2018 PhD Works Summer 2018 Application

https://docs.google.com/forms/d/1i-1GmNC1wmEIGmSuhpPiHuOFNH9VK1X75Pj6X0AyFv0/edit 3/5

10. What is your citizenship? *Mark only one oval.

U.S. Citizen

Non-U.S. Citizen Permanent Resident (e.g., greencard holder)

Non-U.S. Citizen on temporary visa

Prefer not to answer

11. What is your gender? *(e.g., male, female, transgender, other non-binary,prefer not to say, etc)

12. What is your race and/or ethnicity? *Please check all that apply.Check all that apply.

White Non-Hispanic

Hispanic or Latino/a

Asian

Pacific Islander or Native Hawaiian

Black or African American

Native American or American Indian or Alaskan Native

Other:

13. If you identify with any of the following groups that are underrepresented in various fields orhave demonstrated commitment to diversifying the professional workforce in one or more ofthese areas, and you believe that your participation in PhD Works would help advance ourdiversity goal, please select all of the following that apply. This question is optional.Check all that apply.

Gender identity

LGBTQ+

Women in science

Disability

Socioeconomically disadvantaged background (e.g., Pell eligible)

Veteran

Ethnic/racial minority

Commitment to advancing diversity (please explain in next question)

Prefer not to say

Other:

6/12/2018 PhD Works Summer 2018 Application

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14. If you would like to explain or expand upon your response to the previous question, pleaseuse the box below.If you would prefer to communicate about these issues through another method, please let us know,and we can contact you directly.

Application Materials

Please upload below a CV/resume that highlights your careerexploration activities, skills and research-relatedaccomplishments that may be relevant to your careerdevelopment.

15. Please upload your CV (PDF) here:(2 page maximum)Files submitted:

Please upload below a document that addresses the followingshort answer questions:

(1.) Briefly describe how the skills, knowledge or experience you hope to gain during the funded activity could potentially benefit your career development. (250 words maximum) (2.) State the ways in which you believe you will contribute to the diversity on campus or your field of study/interest, in your long term goals to carry out your social responsibility as a future leader and/or educator. Additionally, please tell us how the award would help you realize these goals. It would be helpful to include any information related to their academic/social experience relevant to this mission. (500 words maximum)

16. Upload your short answer document (PDF) here:Files submitted:

Please upload a budget detailing the requested funds.

The total budgeted amount may not exceed $750. In addition to a detailed budget, please include original receipts for past expenses and/or documentation for any estimated expenses, all in one combined PDF file.

17. Upload your budget document (PDF) here: *Files submitted:

Thank you for applying to PhD Works! You will receive aresponse from us after your application is processed. If you have

6/12/2018 PhD Works Summer 2018 Application

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any questions about your application, please emailLyl.Tomlinson@stonybrook.edu

A copy of your responses will be emailed to lyl.tomlinson@stonybrook.edu