Halpern Award

Halpern Award Application

An application for those wishing to receive the Melvin A. Halpern and Maria Cristina Alfonzo Halpern Fund.

Applicant Information
Applicant Name:*
First Last
UNC-CH PID:*
Date of Birth:*
Date of Enrollment:*
MM slash DD slash YYYY
Expected Graduation Date:*
MM slash DD slash YYYY
Permanent Home Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Permanent Telephone:*
Permanent Email:*
Local Address:*
Street Address Address Line 2 City State ZIP Code
Local Telephone:*
Local Email:*
GPA (minimum 3.2)*
Will you be returning to UNC for at least one semester after completion of Halpern supported activity?*
- Yes
- No
Proposed Departure Date:*
MM slash DD slash YYYY
Proposed Return Date:*
MM slash DD slash YYYY
Please provide an abstract of the project in the space provided below (100 words):*
Upload Narrative Proposal (500 words):*
Max. file size: 98 MB.
Upload Resume / CV:*
Max. file size: 98 MB.
Upload Budget:*
Max. file size: 98 MB.
Upload Proof of Language Efficiency:
Max. file size: 98 MB.
Please use the scale below to describe your relevant language proficiency:*
Relevant Language: Proficiency:

Scale: 1 - None; 2 - Beginning; 3 - Intermediate; 4 - Advanced; 5 - Native
Upload IRB Approval or Exemption (if available):
Max. file size: 98 MB.
Please provide the name of the person who will submit your letter of recommendation.*
Country(ies) to be Visited:*
In-Country Contact(s):*
Country: Contact Name: Contact Email: Contact Telephone:
Name and contact information of a person who will know how to reach you in the event that we need to contact you regarding the fellowship:*
Signature of Applicant:*

By entering your name in the signature of applicant entry you are hereby signing the form.

Halpern Award Application

Applicant Information

Institute for the Study of Americas

Stay Connected!

Relevant Language:	Proficiency:

Country:	Contact Name:	Contact Email:	Contact Telephone: