Fellow & Partner Application, Aug 2021 CHECK LISTCHECK LIST: You will be required to upload and submit the following documents (PDF file format): Personal Essays (2) CV/Resume Photo (headshot) GENERAL INFORMATIONDCI encourages our applicants to provide demographic information, as doing so gives us a better picture of the diversity of our applicants and participants so that we can better serve them, as well as measure the effectiveness of our diversity, equity, and inclusion efforts. This data is for internal and research purposes only.First Name* Middle Name or Initial Last Name* Email* Applying As:* Fellow Partner Name of Spouse or Significant Other (First, Last) Date of Birth (mm/dd/yyyy)* MM slash DD slash YYYY Place of Birth (City, Country)* Are you a US Citizen or a Permanent Resident?*YesNoPlease indicate how you identify yourself (select all that apply):* American Indian or Alaska Native (including all Original Peoples of the Americas) Asian (including Indian Subcontinent and Philippines) Black or African American (including Africa and Caribbean) Hispanic or Latino (including Spain) Native Hawaiian or Other Pacific Islander (Original Peoples) White (a person having origins in any of the Original Peoples of Europe, the Middle East, or North Africa) Decline to state Please indicate the gender you identify with (select all that apply):* Female/Woman Male/Man Nonbinary Trans/Transgender Other Decline to state Do you identify yourself as a first generation college student? This means that neither of your parents completed a 4-year college or university degree.* Yes No Not sure Decline to state PERMANENT ADDRESS Street Address * Address Line 2 City * State / Province / Region * ZIP / Postal Code * Country * AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone (e.g. 650-555-1212)*International Phone Code (e.g. country code, area code, local number) EDUCATIONAL HISTORYHighest Education Received*ChooseUndergraduate DegreeMaster's DegreeDoctoral or Professional DegreeUndergraduate Institution Undergraduate Degree Graduate Institution Graduate Degree Additional Graduate or Professional Institution Additional Graduate or Professional Degree Are you a Stanford Alum or have attended a Stanford professional program? Select all that apply. Stanford Undergraduate Stanford Graduate Graduate School of Business School of Earth, Energy & Environmental Sciences Graduate School of Education School of Engineering School of Humanities & Sciences School of Law School of Medicine Additional Information PURPOSE PATHWAYSThe Purpose Pathway is a key component of the Stanford Distinguished Careers Institute. Each fellow undertakes a Purpose Pathway in one of the broad interdisciplinary areas listed below. More information on Purpose Pathways can be located at https://dci.stanford.edu/scholarly-pathway/.DCI PURPOSE PATHWAY - Please select 1-2 pathway(s).* Arts & Humanities Business, Leadership, Entrepreneurship Education, Teaching, Learning Energy and the Environment Engineering Sciences and Design Health and Health Care Independent Studies International Studies Social Sciences, Policy, Public Service PERSONAL ESSAYSPlease provide your replies to both questions in a PDF file format document.Essay 1*1. Please review the list of Purpose Pathways and comment on one that is of greatest interest to you. Why does it interest you and how does it fit into your future direction as you envision it now? This is not a commitment - a Fellow's or Partner’s choice of pathway is open to change once the year is underway. Please keep your answer to 1-2 pages. *Max. file size: 50 MB.Essay 2*2. What would you hope to gain from a year at Stanford as a Distinguished Careers Institute Fellow? What specific skills, knowledge, and experience would you hope to contribute to the DCI and the Stanford community? Please keep your answer to 1-2 pages. Max. file size: 50 MB.CURRICULUM VITAE & PHOTOPlease provide your resume or curriculum vitae in a PDF file format.*Max. file size: 50 MB.Please provide a photo of yourself (Optional, but encouraged).Max. file size: 50 MB.REFERENCES (only required if applying as a fellow)Please provide the name, email address and telephone number of one individual whom we can contact as a confidential reference for your application. We would prefer someone who can tell us about you as person rather than you as a professional. We will reach out to you prior to contacting your reference and one is not required for a DCI Partner application. Your reference should not be a DCI alumnus.Reference Name Reference Email Reference Phone NumberHow did you hear about DCI?* Article DCI Fellow/Partner Referral Internet Search Instructor Email Personal Referral Social Media Staff Referral Other Other: Source or Referral Name DCI LONGITUDINAL RESEARCH PROJECTUnderstanding the impact of DCI on the life journey of the individual is a critical component of our program and, as such, we are conducting a longitudinal research project. Our goal is full participation from all DCI Fellows and Partners in all DCI surveys and interviews conducted during the DCI year and beyond. Please contact us if you have any questions or concerns about DCI research.Would you be interested in participating in this research regardless of the outcome of your application to become a DCI Fellow?* Yes No PhoneThis field is for validation purposes and should be left unchanged.
