LEEP Project Application AY16
LEEP Projects/LEEP Fellows Agreement
Students should read through this section carefully. Submission of a LEEP Project signals that you understand and agree to the requirements of LEEP Projects and the LEEP Fellows
program. I recognize that the LEEP Projects/LEEP Fellows experience is multifaceted and includes pre-project advising, support, and training; completion of a project; and post-project advising, reflection, and presentation.
Specifically, I understand that I am expected to:
1. Complete all components of the application on time, including: a. Application form
b. Project description c. LEEP essay
d. Letter of recommendation e. Résumé
f. Relevant risk/liability forms 2. Complete the online Moodle tutorial
3. Attend the LEEP Project boot camp on May 11, 2016* 4. Submit a final reflection and project report
5. Attend post-project workshops
6. Participate in LEEP Talks or Fall Fest and submit poster/talk for archiving 7. Participate in Exit Interviews - optional
*Students who are currently studying abroad are exempt from the boot camp, and boot camp materials will be made available at a later date.
I also understand that it is my responsibility to be in regular touch with my faculty mentor and keep him/her updated on my progress.
Finally, I understand that, by completing a LEEP Project and/or participating in the LEEP Fellows Program, I am representing Clark University, and I agree to comport myself appropriately and abide by the standards set forth in the Student Code of Conduct. I understand that, if I do not complete all components of the LEEP Project/LEEP Fellow experience, if I fail to work with my faculty mentor, and/or if I do not abide by the standards of the Student Code of Conduct, I am at risk of losing LEEP funding and/or expulsion from the LEEP Fellows Program until such time as I have met the requirements or returned any funds awarded up to that point.
Please have all your information ready prior to beginning the application. Your progress should be saved for up to two weeks if you exit partway through and visit this page from the same computer, but if it fails to save then you will need to start over. For a list of existing projects, please visit the Clark Recruiter's LEEP Projects page. You may also wish to view a preview of the survey before beginning.
I agree to the terms outlined above. You must agree to the terms in order to continue the application.
Yes No
Thank you for taking the time to apply for a LEEP Project. This project will give you the opportunity to take what you've learned at Clark and explore its real-world applications. If you have any questions regarding the application process, you may contact Ruby Maddox, Director of LEEP Projects, via e-mail or telephone at (508) 793-7586.
First Name Last Name
Clark University e-mail address
Clark ID Number (Eight digit number beginning with "70") Campus Box Number
Phone Number Major (Primary)
Major (Secondary) (if applicable) Minor/Concentration 1 (if applicable) Minor/Concentration 2 (if applicable) Year of Graduation
Citizenship
US citizen/Permanent Resident
International Student (F-1 or J-1 visa status) ____________________
GPA
Application Checklist
Please upload your completed LEEP Project Proposal (includes essay). File name must include name of applicant.
Please upload your completed risk/liability form. (Skip this question. The form will be provided prior to the summer.)
Please upload your unofficial transcript. File name must include name of applicant. Are you on academic or social probation?
Yes No
Please have your intended faculty mentor submit a letter of recommendation to
leepcenter@clarku.edu This letter should briefly state that 1) the faculty member agrees to serve as your mentor; 2) the faculty member has read your proposal and thinks the project is worthwhile; and 3) the faculty member believes you are capable of completing the project in the timeframe outlined in the proposal. The mentor may include any additional information, but these letters are not intended to be burdensome; a short note will suffice.
Please answer the following questions regarding your LEEP Project's sponsoring organization. With what type of organization will you be working? Please disregard if you are doing an independent project.
Sponsoring Organization Clark Department
Name of Sponsoring Organization or Clark Department Street Address
City
State (if applicable) Zip Code (if applicable) Country
Website
Please answer the following questions regarding your LEEP Project. LEEP Project Title
Project Abstract (limit: 150 words)
Are you traveling abroad for your project? Yes
No
Please upload the International Travel Application Form. File name must include name of applicant
Where will your project take place primarily? Street Address
City
Zip Code (if applicable) Country
Project Start Date (e.g., 06/13/2016) Project End Date
Estimated hours per week
First name of onsite LEEP Project Supervisor Last name of onsite LEEP Project Supervisor Supervisor E-Mail Address
Are you requesting LEEP Fellows funding? Yes
No
Will you be receiving other compensation/funding for your project? Yes
No
Will you be receiving other compensation/funding for your project?
Answer If Yes Is Selected: How much compensation will you be receiving? Will you be receiving other compensation/funding for your project?
Answer If Yes Is Selected: From whom will you be receiving this funding? Faculty Mentor First Name
Faculty Mentor Last Name Department of Faculty Mentor Faculty Mentor Email Address Faculty Mentor Phone Number
Please enter your emergency contact's information below. Emergency Contact First Name
Emergency Contact Last Name Relationship
Emergency Contact Phone Number Emergency Contact E-mail Address Emergency Contact Street Address Emergency Contact City
Emergency Contact State (if applicable) Emergency Contact Zip Code (if applicable) Emergency Contact Country
Any additional comments or questions?
Click below to submit the LEEP Project Application. Please ensure you have completed the application in its entirety before submitting.
