The W.K. Kellogg Foundation Fellowship in Health Research

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1 FELLOWSHIP PROGRAM Candidate Instruction Sheet National Medical Fellowships, Inc. has established a fellowship program to create a cadre of health researchers with a focus in one of our areas: health policy, men s health, mental health, and substance abuse. The program will award fellowships to talented minority men or women enrolled in graduate programs in public health, health policy or social policy leading to the doctorate (Ph.D., Dr.P.H., or Sc.D.). The fellowship will provide the opportunity to complete advanced training in research methodology, including quantitative and qualitative methods. The expectation is that the Fellows who graduate from the program will be a resource for government agencies, managed care organizations, community health centers, research institutions and academia. APPLICANTS MUST FIRST BE ACCEPTED FOR ADMISSION TO THE HELLER GRADUATE SCHOOL OF BRANDEIS UNIVERSITY, THE MAILMAN SCHOOL OF PUBLIC HEALTH AT COLUMBIA UNIVERSITY, THE HARVARD SCHOOL OF PUBLIC HEALTH, THE JOHNS HOPKINS SCHOOL OF HYGIENE AND PUBLIC HEALTH, THE RAND GRADUATE SCHOOL, THE UCLA SCHOOL OF PUBLIC HEALTH, THE UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH OR THE UNIVERSITY OF PENNSYLVANIA IN ORDER TO BE CONSIDERED FOR THE W.K. KELLOGG FOUNDATION FELLOWSHIP IN HEALTH RESEARCH. AWARD The fellowship award will cover tuition, fees and a partial living stipend for up to five years. ELIGIBILITY Applicants must meet ALL of the following criteria: Enrollment in, or acceptance for enrollment for the academic year at the RAND Graduate School, The University of Michigan School of Public Health, Brandeis University, The Heller Graduate School, UCLA School of Public Health, The Mailman School of Public Health at Columbia University, The Harvard School of Public Health, The Johns Hopkins School of Hygiene & Public Health or The University of Pennsylvania Be a member of one of the following minority groups African-American, Asian, Hispanic, and Native American. American Indians must submit an CDIB or a certificate of Indian heritage from a tribe. All candidates must be U.S. citizens or permanent residents. Demonstrate a commitment to work with underserved populations upon completion of the doctorate. Exhibit a willingness to complete relevant dissertation research. OVER

2 Application Requirements The required application materials include: An up-to-date resume or curriculum vitae. An essay of 500 to 1,000 words discussing why you are applying for a fellowship, your qualifications, your interest in one of the areas of focus, and how the fellowship will support your career plans. Three letters of recommendation one professional, one academic and one other. Letters should describe applicant s character, background, analytical capabilities and demonstrated interest in health policy and health policy research. Official transcripts from all undergraduate and graduate schools. Financial Aid Information Release Copies of any published articles, abstracts, etc. THE SELECTION PROCESS The deadline for receipt of applications by National Medical Fellowships, Inc. is June 30, The National Advisory Committee will select Fellows on the basis of academic accomplishments, research potentials, demonstrated interest and ability in health policy research, and commitment to working with underserved populations. Designated Fellows will be announced in summer of Coursework must begin, or continue, at participating institutions the following fall. THE ORIGINAL AND ONE COPY OF ALL APPLICATION MATERIALS SHOULD BE FORWARDED BY June 30, 2003 TO: National Medical Fellowships, Inc K St. NW, Suite 1200 Washington, DC Tel: (202) Facsimiles will not be accepted. Please staple but do not bind your applications.

3 Application Form PLEASE TYPE OR PRINT IN INK I am applying to: I have been accepted to: Brandeis University, The Heller Graduate School The Mailman School of Public Health at Columbia University University of Michigan School of Public Health The Johns Hopkins School of Hygiene & Public Health The RAND Graduate School UCLA School of Public Health The Harvard School of Public Health University of Pennsylvania APPLICANTS MUST FIRST BE ACCEPTED FOR ADMISSION TO THE HELLER GRADUATE SCHOOL OF BRANDEIS UNIVERSITY, THE MAILMAN SCHOOL OF PUBLIC HEALTH AT COLUMBIA UNIVERSITY, THE HARVARD SCHOOL OF PUBLIC HEALTH, THE JOHNS HOPKINS SCHOOL OF HYGIENE AND PUBLIC HEALTH, THE RAND GRADUATE SCHOOL, THE UCLA SCHOOL OF PUBLIC HEALTH, THE UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH OR THE UNIVERSITY OF PENNSYLVANIA IN ORDER TO BE CONSIDERED FOR THE W.K. KELLOGG FOUNDATION FELLOWSHIP IN HEALTH RESEARCH. Name: Last First MI SSN: How did you hear about this fellowship? (Please be as specific as possible): Date of Birth: Place of Birth : Gender: Male Female U.S. Citizen: Yes No If naturalized citizen, please provide certificate number and include proof of citizenship. How many years have you resided in the US? If Permanent Resident, provide number and copy of green card Ethnicity: Address: Current Address (Use until / / ): Number Street Apt. # City State Zip Telephone Permanent Address: Number Street Apt. # City State Zip Telephone

4 EDUCATION Beginning with most recent attendance, list graduate and undergraduate schools: NAME OF SCHOOL (CITY, STATE) DEGREE RECEIVED-MAJOR DATES OF ATTENDANCE HONORS AND AWARDS List all honors or merit awards received in undergraduate, graduate or professional school: NAME OF AWARD AWARDING ORGANIZATION DATE(S) RECEIVED RESEARCH FELLOWSHIPS List any research fellowships received in undergraduate, graduate or professional school: NAME OF FELLOWSHIP PURPOSE DATE(S)

5 Describe relevant research or clinical clerkships: discuss nature of research, where conducted and the name of preceptor or principal investigator; describe project funding and level of support. (Use additional sheets if necessary): Please list relevant work experience (Use additional sheets if necessary): Briefly describe your anticipated area of research during the fellowship. (You may elaborate further in your personal statement): Please include curriculum vitae. Signature: Date: THE DEADLINE FOR RECEIPT OF APPLICATION MATERIALS IS JUNE 30, Please forward original and one copy of all required application to: National Medical Fellowships, Inc K St. NW, Suite 1200 Washington, DC Tel: (202)

6 Application Checklist Completed Application Financial Aid Information Release Resume or curriculum vitae Personal essay Three letters of recommendation one professional, one academic and one other Official original transcripts Copies of publications, abstracts, etc. THE ORIGINAL AND ONE COPY OF ALL APPLICATION MATERIALS SHOULD BE FORWARDED BY JUNE 30, 2003: National Medical Fellowships, Inc K St. NW, Suite 1200 Washington, DC Tel: (202) Facsimiles will not be accepted.

7 Personal Statement (PLEASE TYPE) Name: Last First MI SSN: Current Address: (Number, Street, Apt. #) City State Zip Telephone INSTRUCTIONS: Write an essay of no more than 1000 words and not less than 500 discussing why you are interested in pursuing doctoral studies in health policy, how you expect to use the skills and knowledge you would acquire, and how the fellowship would further your career plans. Indicate which of the four areas of focus (health policy, men s health, mental health, substance abuse) you are interested in and why. Any past work experience in health policy or with medically underserved populations should be highlighted. If you prefer, you may attach your statement to this form.

8 Financial Aid Information Release INSTRUCTIONS: The size of the fellowship stipend will vary according to individual and school budgets. National Medical Fellowships, Inc. will need to verify your personal budget with your school s financial aid office. Please complete and sign this form and return by the designated deadline date with the required application materials. Name: Last First MI SSN: I authorize the Student Financial Aid Office at (check one) Brandeis University, The Heller Graduate School The Mailman School of Public Health at Columbia University University of Michigan School of Public Health The Johns Hopkins School of Hygiene & Public Health The RAND Graduate School UCLA School of Public Health The Harvard School of Public Health University of Pennsylvania to release pertinent financial aid information National Medical Fellowships, Inc. in support of my application for a W.K. Kellogg Foundation Fellowship in Health Research. (Applicant s Signature) (Street Address) (City) (State) (Zip) The deadline for receipt of application materials is June 30, Please forward the original and one copy of this form and recommendation letter to: National Medical Fellowships, Inc K St. NW, Suite 1200 Washington, DC Tel: (202) FACSIMILES WILL NOT BE ACCEPTED.

9 Recommendation Form Name of Applicant: TO THE APPLICANT: Sign the consent statement below and give this form to a professor or professional colleague who knows you well enough to write a recommendation. I authorize to provide National Medical Fellowships, Inc. with a personal evaluation in support of my application for a Fellowship. I hereby waive do not waive my right of access to this information in accordance with the Family Education Rights and Privacy Act of Applicant s Signature Date TO THE RECOMMENDER: The above named person is applying for a fellowship to support doctoral studies in one of the following areas: health policy, men s health, mental health, and substance abuse. Candidates should be capable of performing academic work at the doctoral level and should have demonstrated a commitment to working with minority and underserved populations. We would appreciate your frank comments on the candidate. Name: Title: Institution: Address: City: State: Zip Code: Telephone: OVER

10 How long and in what capacity have you known the applicant? On separate sheets, please write your assessment of the applicant s strengths as well as any limitations that may have a bearing on his/her performance in an intensive doctoral program, citing his/her personal attributes, research capabilities, experience, past performance or other factors that the Selection Committee should take into account in their decision. If you prefer, you may attach a detailed letter to this form. The deadline for receipt of application materials is June 30, Please forward the original and one copy of this form and recommendation letter to: National Medical Fellowships, Inc K St. NW, Suite 1200 Washington, DC Tel: (202) Facsimiles will not be accepted.

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