Fellowship Application Form
Provide your applicant and project details, then describe the opportunity, plan, outcomes, and leadership support for Spring 2027.
Applicant and Project Information
Project Title
*
Full Name
*
First Name
Last Name
Title
*
Department or Unit
*
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Applicant Type
*
Faculty
Staff
Supervisor Name
*
Supervisor Title
*
Supervisor Email
*
example@example.com
Is a Course Involved?
*
Yes
No
Will Students Participate?
*
Yes
No
Not yet determined
Which Pathway Best Describes Your Project?
*
Please Select
Commercialization readiness
Product, service, or software
Licensing or external adoption
Process or workflow innovation
Teaching and curriculum
Project Brief Description
*
0/250
Project Proposal
Project Summary
*
0/3000
Proposed Activity
*
0/3000
Current Status
*
Idea
Course concept
Early prototype
Existing innovation
Other
Other Status (if applicable)
Work Completed to Date
*
0/150
Intended Outcome
*
0/300
People and Partnerships Involved in Project
*
0/300
LSSU Leadership Support
Endorsing leader
*
Same as listed above
Other
Name
*
Title
*
Email
*
example@example.com
Supervisor's Project Support/Approval Letter or Email
*
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Note
Acknowledgments
Acknowledgments
*
This application contains no confidential or proprietary information
If selected, I will attend the cohort kickoff, participate in biweekly check-ins, and present at the April 2027 showcase and submit a brief final project outcome summary
If selected, I will provide the written intellectual property confirmation before project funds are released
If selected, I will submit brief outcome reports at six and twelve months after the program
Additional Fellowship Project Update Requirements
Fellows share their work in two short posts, one at the start and one at the close of the fellowship. Headwaters North handles editing and publishing. Instructions will be sent to fellows at the beginning of the project.
Acknowledgments
*
I am responsible for providing updates to Headwaters North at the start and close of the fellowship. I understand that they may request updates throughout the fellowship.
Submit Application
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