Apply for The AIP State Department Science Fellowship

Please refer to the Application Materials Required and the Application Process Instructions on the previous page or available here for detailed information. Submission of this web-form is a required part of your application.

Applicant's Information

* Indicates a required field.

Contact information

*First name:

*Last name:

*Address 1:

Address 2

*City:

*State:

*Zip code:

*Phone:

Additional phone:

*E-mail:

Alternate e-mail:

*Which AIP Member society do you belong to? (check all that apply):

	Acoustical Society of America
	American Association of Physicists in Medicine
	American Association of Physics Teachers
	American Astronomical Society
	American Crystallographic Association
	American Geophysical Union
	American Physical Society
	AVS: Science & Technology of Materials, Interfaces, and Processing
	Optical Society of America
	The Society of Rheology

*Your PhD status:

	I have a PhD	Year received:
	I'm expecting my PhD	Month and year expected:

*Citizenship

I am a citizen of the United states (U.S. citizenship required)

Where did you learn about the State Department Fellowship Program?

*Electronic Signature
By submission of this form you are certifying that all application materials and information are true and correct to the best of your knowledge.

Questions? Contact Jennifer Greenamoyer at 1-301-209-3104 or