Bates College | Watson Fellowship Application Form

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	Watson Fellowship Application Form Nomination Applicant Pool

Personal Information:

First Name:

Last Name:

Bates ID

Expected date of graduation:

Month		Year

Local address:


Campus Mailbox Number:				E-mail:

Physical Address: (dormitory, off-campus)				Telephone Number: (all seven digits)


My telephone number is:	On Campus		Off Campus

Permanent Address:


Email:

Postal Address:

Telephone Number (all seven digits plus area code):


Academic Discipline (Please list all majors declared and to be completed by graduation)

(This information has been requested by the Watson Foundation in the past for its own internal analysis of the applicant pool — it is compiled by the Bates College Watson Fellowship Committee and at most only the totals will be reported to the Foundation, without reference to your application.)

1)	2)

3)	4)

Gender Self-Identification: (Please check one)

Male		Female

Ethnic Self-Identification: (Check only the one that you feel fits you best)

	African American		White American
	Asian American		Other/Unspecified
	Hispanic American		Resident Alien
	Native American

Have you studied abroad during college?

Yes		No

"I understand that the Watson Fellowship Committee may examine my Bates College transcript as part of the evaluation process."

Applicant Signature
		(Type in your name)