ࡱ>  bjbjX+X+ M:Ag:Ag<?zz # #\#\#\#p#p#p#8#d %p#<&(:)))*+\.,0~~~~~~~$Z \#^,*"*^,^,  # #))f.f.f.^, #8)\#)~f.^,~f.f.Jcu\D#{|)Pv[,:wB~ 0<xz*2-*{|*\#{|T^,^,f.^,^,^,^,^,  -^,^,^,<^,^,^,^,*^,^,^,^,^,^,^,^,^,zX !: 2023-2024 Dolores Zohrab Liebmann Fund Application The Dolores Zohrab Liebmann Fund was established by the Will of Dolores Zohrab Liebmann and is administered by JPMorgan, Trustee. Mrs.Liebmann was the daughter of a prominent Armenian intellectual, writer and statesman and was married to one of the owners of a successful American business. She supported students and educational and charitable organizations during her lifetime. Mrs. Liebmann's primary concern, as expressed in her Will, was to attract and support students with outstanding character and ability who hold promise for achievement and distinction in their chosen fields of study. The trustees welcome applications from students of all national origins who are United States citizens. Personal & Graduate School Information Name of Applicant: ______________________________________________________ US Citizen:  FORMCHECKBOX  Yes  FORMCHECKBOX  No Last four digits of SSN: __________________________________________ Date of Birth: __________________________________ Location of Birth: ___________________________________ Marital Status:  FORMCHECKBOX Single  FORMCHECKBOX Married Name of Spouse: ___________________________________ Mailing Address: _____________________________________________________________________________________ Mobile/Daytime Phone: _______________________________________________________________________________ E-mail Address: ______________________________________________________________________________________ Name of Graduate School Attending: _____________________________________________________________________ Graduate Degree being sought: ________________ Major Field of Study: ________________________________ Month/Year Expected to Complete Graduate Studies: ____________________________ Have you applied for the Liebmann Fellowship in the past?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, in what year: _________________ Educational History Name of Institution: ________________________________________________________________________________ Degree: ____________________________________ Major Field of Study: _________________________________ Completion Date: __________________________________________________________________________________ Name of Institution: ________________________________________________________________________________ Degree: ____________________________________ Major Field of Study: _________________________________ Completion Date: __________________________________________________________________________________ Name of Institution: ________________________________________________________________________________ Degree: ____________________________________ Major Field of Study: _________________________________ Completion Date: __________________________________________________________________________________ Graduate Exam Test Scores  FORMCHECKBOX GRE Month/Year of Exam: ___________________________ Score: ____________________  FORMTEXT        FORMCHECKBOX GMAT Month/Year of Exam: ___________________________ Score: ____________________  FORMTEXT        FORMCHECKBOX LSAT Month/Year of Exam: ___________________________ Score: ____________________  FORMTEXT        FORMCHECKBOX  FORMTEXT       Month/Year of Exam: ___________________________ Score: ____________________  FORMTEXT        FORMTEXT       Financial Information Tuition amount you expect to pay for 2023-2024 less scholarships & fellowships:______________________ Will this tuition amount vary significantly in future years?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please explain: ____________________________________________________________________ Room and Board you expect to pay next year: ___________________________________________________ Estimated Annual Budget for next year Books/Equipment/Supplies/Mandatory Fees: ___________________ Health/Medical: _____________________ Utilities/Phone: ____________________________________________ Clothing: ___________________________  FORMTEXT       Household/Laundry: ________________________________________ Commute/Transportation: _____________  FORMTEXT       Current Liabilities Name of Lender: __________________________________ Type of Loan: ___________________________ FORMTEXT       Date Incurred: ____________________________________ Balance Due: ___________________________ Due date for full payment: __________________________ Monthly Payment Amount: _________________  FORMTEXT       Currently in Deferred status:  FORMCHECKBOX  Yes  FORMCHECKBOX  No Name of Lender: __________________________________ Type of Loan: ___________________________ FORMTEXT       Date Incurred: ____________________________________ Balance Due: ___________________________ Due date for full payment: __________________________ Monthly Payment Amount: _________________  FORMTEXT       Currently in Deferred status:  FORMCHECKBOX  Yes  FORMCHECKBOX  No Name of Lender: __________________________________ Type of Loan: ___________________________ FORMTEXT       Date Incurred: ____________________________________ Balance Due: ___________________________ Due date for full payment: __________________________ Monthly Payment Amount: _________________  FORMTEXT       Currently in Deferred status:  FORMCHECKBOX  Yes  FORMCHECKBOX  No Name of Lender: __________________________________ Type of Loan: ___________________________ FORMTEXT       Date Incurred: ____________________________________ Balance Due: ___________________________ Due date for full payment: __________________________ Monthly Payment Amount: _________________  FORMTEXT       Currently in Deferred status:  FORMCHECKBOX  Yes  FORMCHECKBOX  No Name of Lender: __________________________________ Type of Loan: ___________________________ FORMTEXT       Date Incurred: ____________________________________ Balance Due: ___________________________ Due date for full payment: __________________________ Monthly Payment Amount: _________________  FORMTEXT       Currently in Deferred status:  FORMCHECKBOX  Yes  FORMCHECKBOX  No Name of Lender: __________________________________ Type of Loan: ___________________________ FORMTEXT       Date Incurred: ____________________________________ Balance Due: ___________________________ Due date for full payment: __________________________ Monthly Payment Amount: _________________  FORMTEXT       Currently in Deferred status:  FORMCHECKBOX  Yes  FORMCHECKBOX  No Scholarships and Fellowships expected for 2023-2024 Award Year: __________________________ Amount: ______________________________ Eligibility Requirements: ______________________________________________________________________ ____________________________________________________________________________________________ Award Year: __________________________ Amount: ______________________________ Eligibility Requirements: ______________________________________________________________________ ____________________________________________________________________________________________ Award Year: __________________________ Amount: ______________________________ Eligibility Requirements: ______________________________________________________________________ ____________________________________________________________________________________________ Award Year: __________________________ Amount: ______________________________ Eligibility Requirements: ______________________________________________________________________ ____________________________________________________________________________________________ Required Supplemental Documentation If mailing in documents they should be single-sided and attached to the completed Application in the order listed below using one binder clip. NO STAPLES PLEASE. One copy of your personal vitae or rsum. One certified copy of each undergraduate and graduate transcript to date. One copy of your graduate exam test scores. A Statement of Purpose up to three pages long (double spaced) which considers the relationship between your graduate level study and your intended personal and/or professional goals. Your Statement of Purpose must include a 10-15 line abstract at the top (included in the three pages) that explains, in LAYMANS terms, the essence of your proposed topic of study or dissertation, the methodology of its treatment and its anticipated impact on your field of study. Letter of Recommendation from Dean of Graduate School or Department Chair. (Optional) Letters of Recommendation from at least two professors who have taught or worked closely with you. (Required) One copy of your Free Application for Federal Student Aid (FAFSA). One copy of your Financial Aid Summary from your school. One copy of your Federal Income Tax Return for the prior two years (including spouses returns, if applicable). Only submit Tax Form, no attachments. Application Process The application process is handled entirely by your graduate school. For more information on applying, please contact the office at your graduate school where you obtained this application. DO NOT CONTACT JPMORGAN OR MEMBERS OF THE SELECTION COMMITTEE. Fellowship Conditions Fellowships are available to students who are enrolled in a graduate program and pursuing a graduate degree at a designated institution of higher learning at the time of application. Individuals applying to graduate programs are no longer qualified candidates. The list of designated institutions can be reviewed on-line at  HYPERLINK "http://foundationcenter.org/grantmaker/liebmann/" http://foundationcenter.org/grantmaker/liebmann/. An applicant may be pursuing a program of study that includes any recognized field of study in the humanities, social sciences, or natural sciences (including law, medicine, engineering, architecture or other formal professional training). The selection committee has a strong preference for supporting scholarly endeavors. An applicant must have an outstanding undergraduate record. An applicant must demonstrate financial need. An applicant must be a citizen of the United States of America. The amount of each Fellowship will cover actual tuition cost (no fees) plus an $18,000 annual stipend to be allocated towards room, board and ordinary living expenses, as well as any income taxes thereon. The recipient of a Fellowship shall be known as a Dolores Zohrab Liebmann Fellow. A Fellowship is awarded on an annual basis. Each Fellow must apply for renewal of his or her Fellowship by March 31st of the following year in accordance with the terms in effect at the time the fellowship is awarded. Fellowships are limited to a maximum of three years. If an applicant is selected and needs to defer to study abroad an email must be sent to JPMorgan contact notifying as such and can only be deferred once up to one academic year. A Fellow must remain enrolled in a graduate program and pursuing a graduate degree at a designated institution. A Fellow must conduct studies in the United States of America. A Fellowship may be canceled at any time if a Fellow engages in misconduct affecting the Fund, breaches any of these rules or provides false information to the Fund either directly or indirectly. A Fellow agrees to have his or her name published and identified as a Dolores Zohrab Liebmann Fellow. The qualifications and selection of candidates to receive the benefits of the Fellowship, the selection or approval of the programs of study to be pursued and the places or the institutions where such studies are pursued, and the meaning, interpretation and application of the provisions of the Will of Dolores Zohrab Liebmann establishing the Fellowship, shall be determined in the sole judgment and discretion of the Trustee, based upon the advice and counsel of a Selection Committee. Certification I have read the conditions of the Dolores Zohrab Liebmann Fellowship Program contained herein and agree to abide by them. 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I understand that any false or incorrect information may disqualify me for this Fellowship. I certify that I am not a JPMorgan Chase Bank, N.A. or affiliates employee or employee's immediate family member. Immediate family member is defined as spouse, domestic partner, child (natural, adopted or step), parent or step-parent, sibling (natural, half, adopted or step) father- or mother-in-law, grandparent, niece, nephew, or spouse / domestic partner of a child, parent, sibling, grandparent, niece or nephew. ___________________________________________________  FORMTEXT       /  FORMTEXT      /  FORMTEXT       Signature of Applicant Date  For Use by the Submitting School Fellowship Coordinator Only The application and supplemental documents attached hereto represents an official candidate from the graduate school I represent to the Dolores Zohrab Liebmann Fund for consideration of the candidate as a Dolores Zohrab Liebmann Fellow. The candidate meets the Fellowship Conditions set forth above.  Is Applicant a US Citizen: Required Documents:Included1Application form fully completed2Personal vitae or resume3Certified copy of each UG transcriptCertified copy of each GRAD transcript to date4Copy of Graduate Exam Test Scores5Statement of Purpose (up to 3 pages, double spaced) Must include a 10-15 line abstract at the top as part of the 3 pages. Abstract must explain, in LAYMANS terms, the essence of your proposed topic of study or dissertation, the methodology of its treatment and its anticipated impact on your field of study. Statement must consider the relationship between graduate level study and intended personal and /or professional goals.6Letter of recommendation from Dean of Graduate School or Department Chair (Optional)7Letter of recommendation from professors (at least TWO required)8Copy of your Free Application for Federal Student Aid (FAFSA)9Copy of your Financial Aid Summary from your school10Copy of your Federal Income Tax Return only no schedules or attachments for the prior two years (including spouse if applicable) The application and supporting documentation are complete and organized in the order listed above. Submitted to JPMorgan by: ____________________________________________ _______________________________________ Signature of the Submitting School Official Name of the Submitting School Official ____________________________________________ _______________________________________ Office Telephone Number Title of the Submitting School Official _______________________________________ E-mail Address     ________ PAGE 5 Page  PAGE 1 of  NUMPAGES 5 - The Dolores Zohrab Liebmann Fund Application for 2023-2024 Student NameStudent IDCollege/ProgramDegree Sought §ħƧȧʧ̧Χҧԧ֧vvl[!jQhHhq^CJOJQJUh_CJOJQJhHh+sCJOJQJhq h+sCJOJQJ*jhq hq >*CJOJQJU*j}hq hq >*CJOJQJUhq hq >*CJOJQJhq h+s>*CJOJQJ)jhV >*CJOJQJUmHnHu$jhq hq >*CJOJQJU#[\ϩЩѩ~ $Ifgd d8gdJ=O   gdJ=O   gdJ=O d gdJ=O hH]gdQ )d]^gdq^)d@&]^gd|I^$ hH]a$gd -?[\˨)HƼ}llYF$hJ=OhJ=OCJOJQJRHs^JaJ$hJ=OhJ=OCJOJQJRHs^JaJ 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