ADATC   2011-12 eFellowship Application

Creighton University - Academic Development and Technology Center
http://www.creighton.edu/mentor

Name _______________________________________________  Highest Degree _______________

I have a (check only one)    ____ Nine Month Appointment     ____ Twelve Month Appointment

I have been a full time faculty member at Creighton for _______________ years.

Phone #s --  Office ___________________                 Home ________________________

email Address ____________________________________________________________

I am applying for a fellowship for the     _________ Summer 2011    _________Academic Year 2011-12

        Please note that the 2011-12 fellowship training program will use the following schedule.

        Summer 2011                             May 16, 2011 through August 12, 2011
        Academic Year 2011-12            August 22, 2011 through May 4, 2012

School or College_______________________________________________________

Academic Department______________________________________________________

Academic Title___________________________________________________________

Department Chair  ______________________________________Phone______________

Dean ________________________________________________Phone______________


Fellowship Interest

Prepare a written response to each of the following questions and attach it to your signed application.

1. Why do you want to be an eFellow?

2. What do you expect to obtain from your participation in the eFellowship Program?

3. What specific skills will you bring to the entire group of eFellows during you fellowship?



4. Describe the computer system and the software, including the operating system, that you routinely use at your campus office. (Be specific about the hardware components of the computer)

5. Describe the computer system and the software, including the operating system, that you routinely use at your home office.

(Be specific about the hardware components of the computer)

Are you planning a sabbatical leave during the academic year 2011-12 or 2012-13?   ____ Yes  ____ No

Have you been an eFellow in the past 4 years?  _____ Yes  _____ No

Applicant's Personal Website http://_______________________________________________

Applicant's Signature ________________________________________       Date ___________

Dept. Chairman's Signature ___________________________________       Date ___________

Dean's Signature ___________________________________________       Date ___________

Area VP's Signature ________________________________________        Date ___________ 


Please send your application form and the following items

1. Two letters of recommendation from two different faculty members that are in your academic department. (Not necessary if you have been a previous eFellow.)

2. An optional personal statement you may wish to add in support of your application

3. The Director of the ADATC Center will contact you to schedule a personal interview after receiving all of your application materials. The interview will take place during February or March of 2011.

4. The ADATC Center expects to announce new fellowship appointments by April  15, 2011.

Send your completed application by March 15, 2011 to

W. Wayne Young, Pharm.D.
Director, Academic Development and Technology Center
wyoung@creighton.edu
 Voice 280.5814