COORDINATING COUNCIL FOR WOMEN IN HISTORY

APPLICATION FORM GRADUATE STUDENT AWARD

CCWH/BERKSHIRE CONFERENCE OF WOMEN HISTORIANS AWARD
CCWH/IDA B.WELLS GRADUATE STUDENT AWARD

*IF YOU ARE IN A HISTORY DEPARTMENT CHECK BOTH.

Deadline: October 1, 2003
Award Announced: December 3, 2003

Name:_________________________________________________________________________________

Home
Address:__________________________________________________________________________

City:____________________________State:___________________________Zip:____________________

Home Phone: (______)___________________Message Phone:(______)______________________________

Email Address:_____________________________________________

Dissertation
Title:____________________________________________________________________________________________________

One paragraph abstract of dissertation proposal:














Date completed qualifying examinations or other rite of passage to A.B.D. status,
with signature of departmental representative:

_____________________________
_________________________________________________________
Date Departmental Representative Signature

CCWH Member: Y ( ) or N ( ).
(This is for our information only; membership does NOT affect your chances of selection.)

SUBMIT COMPLETED APPLICATIONS (remember that you need 7 copies of most items)
to: Professor Ann Le Bar, Department of History, Eastern Washington University, Patterson Hall 200, Cheney, WA 99004

For Selection Committee Use Only                Assigned to:

NOTE:  If you are unable to copy and/or print this form,
you may contact Professor Ann Le Bar, Department of History, Eastern Washington University, Patterson Hall 200, Cheney, WA 99004, email: alebar@mail.ewu.edu.