Author: John Wallin
Last saved by: Carrie Robison
Company: Louisiana Board of Regents

APPENDIX B	

PROPOSAL SUBMISSION FORMS

*Form 9-GF:	Summary of Previous Traditional Graduate Fellows Awards
*Form 9-GFT:  Summary of Previous Graduate Fellowships for Teachers Awards
*Form 10-GF (Doctoral Programs):	Profile of Doctoral Program Admissions & Student Support
*Form 10-GF (Master’s Programs):	Profile of Master’s Program Admissions & Student Support
*Form 11-GF (Doctoral Programs):	Profile of Doctoral Students 
*Form 11-GF (Master’s Programs):	Profile of Master’s Students 
  Form 12-GF: 	Profile of Key Graduate Faculty

*  	  Use the appropriate form for the only the program(s) (e.g., doctoral or master’s) for which support is requested in the proposal. If the request is for both master’s and doctoral support, complete separate forms for each level. 

	

FORM 9-GF
	SUMMARY OF PREVIOUS AWARDS RECEIVED UNDER THE BoRSF TRADITIONAL GRADUATE FELLOWS SUBPROGRAM
	
1.	Provide the following information for each Traditional Graduate Fellows contract you and/or your department have received to date.  Do not provide information for individual fellowship recipients, but for each Board of Regents contract. List those awards for which contracts have not yet been written as "contract pending."  

CONTRACT NUMBER

TYPE & NUMBER OF FELLOWSHIPS 
AUTHORIZED BY BOARD

ANNUAL STIPEND AMOUNT FOR
EACH FELLOWSHIP

NUMBER OF FELLOWSHIPS 
FILLED*

STATUS OF FELLOWSHIP RECIPIENTS
(# OF STUDENTS GRADUATED, DROPPED, AND STILL IN PROGRAM)

EMPLOYMENT STATUS OF FELLOWSHIP RECIPIENTS
(# OF FELLOWSHIP RECIPIENTS EMPLOYED IN THE INDICATED CATEGORIES)

| | | | Graduated: Dropped: Still in Program: | Academia in Field: Public Sector in Field: Private Sector in Field: Out of Field: Unknown:
| | | | Graduated: Dropped: Still in Program: | Academia in Field: Public Sector in Field: Private Sector in Field: Out of Field: Unknown:
| | | | Graduated: Dropped: Still in Program: | Academia in Field: Public Sector in Field: Private Sector in Field: Out of Field: Unknown:
| | | | Graduated: Dropped: Still in Program: | Academia in Field: Public Sector in Field: Private Sector in Field: Out of Field: Unknown:
| | | | Graduated: Dropped: Still in Program: | Academia in Field: Public Sector in Field: Private Sector in Field: Out of Field: Unknown:
| | | | Graduated: Dropped: Still in Program: | Academia in Field: Public Sector in Field: Private Sector in Field: Out of Field: Unknown:
| | | | Graduated: Dropped: Still in Program: | Academia in Field: Public Sector in Field: Private Sector in Field: Out of Field: Unknown:
*Provide an explanation for any unfilled awards.

2.	(a)  Provide the range of GRE scores for each level of fellowship recipient you have supported through the BoRSF programs. Do not use composite scores. Select Verbal, Quantitative, or Analytical Writing scores, depending on which is most influential in the admissions process:
         Non-GFT Master's         Ph.D.         Ed.D.         Other (specify): _____      
    (b)  What percentage of your department's BoRSF fellowships has been awarded to underrepresented minority students?          	

FORM 9-GFT
	SUMMARY OF PREVIOUS AWARDS RECEIVED UNDER THE
	BOARD OF REGENTS SUPPORT FUND GRADUATE FELLOWSHIPS FOR TEACHERS SUBPROGRAM

1.	Provide the following information for each Graduate Fellowships for Teachers contract you and/or your department have received to date.  Do not provide information for individual fellowship recipients, but for each Board of Regents contract. List those awards for which contracts have not yet been written as "contract pending."  

CONTRACT NUMBER

NUMBER OF GFT FELLOWSHIPS
AUTHORIZED BY BOARD

ANNUAL STIPEND AMOUNT FOR
EACH FELLOWSHIP

NUMBER OF FELLOWSHIPS
FILLED*

EDUCATIONAL STATUS OF FELLOWSHIP RECIPIENTS
(# OF STUDENTS GRADUATED, DROPPED, STILL IN PROGRAM)

EMPLOYMENT STATUS OF FELLOWSHIP RECIPIENTS
(NUMBER OF STUDENTS IN EACH CATEGORY)

NUMBER OF STUDENTS WHO FULFILLED POST-AWARD TEACHING COMMITMENT**

| | | | Graduated: Dropped: Still in Program: | LA K-12 classroom: Out-of-state K-12 classroom: Left K-12 teaching: Unknown: |
| | | | Graduated: Dropped: Still in Program: | LA K-12 classroom: Out-of-state K-12 classroom: Left K-12 teaching: Unknown:: |
| | | | Graduated: Dropped: Still in Program: | LA K-12 classroom: Out-of-state K-12 classroom: Left K-12 teaching: Unknown: |
| | | | Graduated: Dropped: Still in Program: | LA K-12 classroom: Out-of-state K-12 classroom: Left K-12 teaching: Unknown: |
| | | | Graduated: Dropped: Still in Program: | LA K-12 classroom: Out-of-state K-12 classroom: Left K-12 teaching: Unknown: |
| | | | Graduated: Dropped: Still in Program: | LA K-12 classroom: Out-of-state K-12 classroom: Left K-12 teaching: Unknown: |
| | | | Graduated: Dropped: Still in Program: | LA K-12 classroom: Out-of-state K-12 classroom: Left K-12 teaching: Unknown: |
*  Provide an explanation for any unfilled awards.
  ** “Individuals to whom institutions award fellowships under the GFT program must sign an affidavit committing themselves to teach at least one semester in Louisiana for each semester they receive the Support Fund fellowship.”  (RFP, p. 3) 

2.	(a)  Provide the range of GRE scores for the GFT fellowship recipients you have supported through the BoRSF subprogram. Do not use composite scores. Select Verbal, Quantitative, or Analytical Writing scores, depending on which is most influential in the admissions process. 
GRE Score Range: ______________________         
    (b)  What percentage of your department's GFT fellowships has been awarded to underrepresented minority students?          	

FORM 10-GF-DOC
DOCTORAL PROGRAM ADMISSIONS & FIRST-YEAR STUDENT SUPPORT 

A. 	Recruitment and Admissions Data

Academic Year

# of Applications to Doctoral Program

# of Offers of Admission Made

# First Enrolled in the Academic Year (i.e., Newly Matriculated)

GRE Average/Range for Newly 
Enrolled Students

GPA Average and Range for Newly Enrolled Students

Indicate category reported***: 
Verbal       Quantitative       Analytical

2012-13

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

2011-12

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

2010-11

Total U.S.:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

2009-10

Total U.S.:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

2008-09

Total U.S.:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

2007-08

Total U.S.:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

*	Includes U.S. citizens and permanent residents
** 	Underrepresented minority, defined as Black/African-American, Hispanic or Latino, American Indian or Alaska Native, and Native Hawaiian or other U.S. Pacific Islander
***	Do not provide composite scores. This has been identified by ETS as an inappropriate use of test scores. Provide only Verbal, Quantitative or Analytical Writing scores, depending on which is most influential in the admissions process. 

B. 	External research support for first-year doctoral students entering in the most recent academic year reported above

a.	Number of first-year doctoral students who received support from any source: _____

	b.	Number of research faculty members who supported first-year doctoral students on federal and/or private-sector awards: ____ 	

FORM 10-GF-MASTER’S
MASTER’S PROGRAM ADMISSIONS & FIRST-YEAR STUDENT SUPPORT 

A. 	Recruitment and Admissions Data

Academic Year

# of Applications to Master’s Program

# of Offers of Admission Made

# First Enrolled in the Academic Year (i.e., Newly Matriculated)

GRE Average/Range for Newly 
Enrolled Students

GPA Average and Range for Newly Enrolled Students

Indicate category reported***: 
Verbal       Quantitative       Analytical

2012-13

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

2011-12

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

2010-11

Total U.S.:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

2009-10

Total U.S.:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

2008-09

Total U.S.:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

2007-08

Total U.S.:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

Total U.S.*:
U.S. URM**:
International:

U.S.:
International:

U.S.:
International:

*	Includes U.S. citizens and permanent residents
** 	Underrepresented minority, defined as Black/African-American, Hispanic or Latino, American Indian or Alaska Native, and Native Hawaiian or other U.S. Pacific Islander
***	Do not provide composite scores. This has been identified by ETS as an inappropriate use of test scores. Provide only Verbal, Quantitative or Analytical Writing scores, depending on which is most influential in the admissions process. 

B. 	External research support for first-year master’s students entering in the most recent academic year reported above

a.	Number of first-year master’s students who received support from any source: _____

	b.	Number of research faculty who supported first-year master’s students on federal and/or private-sector awards: ____ 

FORM 11-GF-DOCTORAL

PROFILE OF DOCTORAL STUDENTS
A. Doctoral Student Population: For each year listed, provide data on the total population of students in the doctoral program(s) for which funding is sought. 
Academic Year (AY) | # of students enrolled in the fall semester of the listed AY | # graduated in the AY with the degree intended | # left the program in the AY without the intended degree** | # continuing in the program at the end of the AY

2012-13

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

2011-12

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

2010-11

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

2009-10

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

2008-09

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

2007-08

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

*  	Include U.S. citizens and permanent residents.
**	Include those students who received a degree, but not at the intended level (e.g., doctoral students who received master’s degrees and left the program)	 

B.	Diversity Report: Provide the total number of doctoral students in each category currently enrolled in the degree program(s) for which support is sought
Total U.S. Enrollment | Black/African-American | American Indian or Alaska Native | Hispanic or Latino | Native Hawaiian or Other U.S. Pacific Islander

C.	Student Support Summary: Provide data only for doctoral students enrolled in the current academic year only 

	1.  Academic-Year Support

# of Students

Federal and Private-Sector Fellowships

Institutional/
Department
Fellowships

Teaching Assistantships

Research Assistantships

Other (Specify)

Total enrolled: ___

# receiving support: __

# self-supporting: ___

# of students:

# of students:

# of students:

# of students:

# of students:

| Range of support: $ | Range of support: $ | Range of support: $ | Range of support: $ | Range of support: $
| Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None
| Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no

	2.  Summer Support 

# of Students

Federal and Private-Sector Fellowships (NIH, etc.)

Institutional/
Department
Fellowships

Teaching Assistantships

Research Assistantships

Other (Specify)

Total enrolled: __ 
# receiving support: __

# self-supporting: __

# of students:

# of students:

# of students:

# of students:

# of students:

| Range of support: $ | Range of support: $ | Range of support: $ | Range of support: $ | Range of support: $
| Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None
| Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no

FORM 11-GF-MASTER’S

PROFILE OF MASTER’S STUDENTS
A. 	Master’s Student Population: For each year listed, provide data on the total population of students in the master’s program(s) for which funding is sought. 
Academic Year (AY) | # of students enrolled in the fall semester of the listed AY | # graduated in the AY with the degree intended | # left the program in the AY without the intended degree** | # continuing in the program at the end of the AY

2012-13

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

2011-12

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

2010-11

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

2009-10

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

2008-09

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

2007-08

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

Total: 
Total U.S.*:
U.S. Women:  
U.S. URM:  
Int’l:

*  	Include U.S. citizens and permanent residents.
**	Include those students who received a degree, but not at the intended level (e.g., doctoral students who received master’s degrees and left the program)

B.	Diversity Report: Provide the total number of students in each category currently enrolled in the master’s program(s) for which support is sought. 
Total U.S. Enrollment | Black/African-American | American Indian or Alaska Native | Hispanic or Latino | Native Hawaiian or Other U.S. Pacific Islander

C.	Student Support Summary: Provide data for all master’s students enrolled in the current academic year only

	1.  Academic-Year Support

# of Students

Federal and Private-Sector Fellowships

Institutional/
Department
Fellowships

Teaching Assistantships

Research Assistantships

Other (Specify)

Total enrolled: ___

# receiving support: __

# self-supporting: ___

# of students:

# of students:

# of students:

# of students:

# of students:

| Range of support: $ | Range of support: $ | Range of support: $ | Range of support: $ | Range of support: $
| Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None
| Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no

	2.  Summer Support 

# of Students

Federal and Private-Sector Fellowships (NIH, etc.)

Institutional/
Department
Fellowships

Teaching Assistantships

Research Assistantships

Other (Specify)

Total enrolled: __ 
# receiving support: __

# self-supporting: __

# of students:

# of students:

# of students:

# of students:

# of students:

| Range of support: $ | Range of support: $ | Range of support: $ | Range of support: $ | Range of support: $
| Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None | Tuition support: Full/Partial (amount)/None
| Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no | Insurance included: yes/no

FORM 12-GF
PROFILE OF GRADUATE FACULTY 

1.  Faculty Overview: Include only faculty involved in graduate program 

Name | Rank | Highest degree earned/year of completion | # of graduate students mentored in previous academic year | Number of refereed publications over last three years

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

Journal Article: 
Monograph:

2.  Faculty Support: List and provide requested information for all faculty members who currently hold more than $50,000 in federal and/or private-sector funding (do not include State, Board of Regents, or institutional awards).

Name | Funding Source(s) and Active Year(s) of Award(s) | Amount(s) Awarded | Amount(s) Allocated for Graduate Student Support