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{\Large{\textbf{PNW NExT (New Experiences in Teaching)\\~\\Fellow Application Form}}}
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\begin{tabular}{p{2in} p{3.5in}}
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\textbf{Name:} & Your Name Here
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\textbf{Address:} & Address Line \#1 \\
							& Address Line \#2 \\
							& Address Line \#3
\\ \\


\textbf{Telephone:} & (111) 111 - 1111
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\textbf{E-mail:} & \href{mailto:youremail@yourdomain.com}{youremail@yourdomain.com}
\\ \\


\hline
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\textbf{Highest Degree:} & Degree, Field
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\textbf{Year, \& Institution:} & 2000, School
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\textbf{Institution where you will be teaching in the next academic year:}  & Describe where you will be teaching for the upcoming academic year.
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\noindent A complete application should also include the following information:

\begin{itemize}
\item[-] a curriculum vita,
\item[-] a brief statement of one's teaching activities (Please include specific examples regarding your approach to teaching and learning as well as a description of what you hope to get out of the program.),
\item[-] a brief statement of one's scholarly activities,
\item[-] a letter of support (Please ask your chair, or other supervisor, to write a statement of support indicating how your participation in Project NExT will benefit your department and the amount of financial support your school can give separate from any annual travel allocations..)
\end{itemize}

\noindent Send one electronic copy of the application packet to \href{mailto: McNulty@mso.umt.edu}{McNulty@mso.umt.edu}.

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