Adjunct Fellows Program
(Form to be completed by applicant)

NAME:__________________________________

CURRENT POSITION:_________________________

UNIVERSITY/COLLEGE AFFILIATION: _________________________________

DEPARTMENT: ______________________________________

ADDRESS:______________________________

OFFICE TELEPHONE:_______________________

E-MAIL ADDRESS:_________________________

For assistance with your application, please contact:

Sandra Gary
Assistant Director
Ph: (706) 542-6100
Fax: (706) 542-6064
sgary@uga.edu