THE 2016 RISE PROGRAMS ONLINE GUIDLINES James A. Ferguson Emerging Infectious Diseases Fellowship Program

Transcription

1 THE 2016 RISE PROGRAMS ONLINE GUIDLINES James A. Ferguson Emerging Infectious Diseases Fellowship Program Thank you for your interest in the James A. Ferguson Emerging Infectious Diseases Fellowship Program. THIS IS A APPLICATION PACKET. IMPORTANT: Please review the instructions before beginning the online application. You MUST complete the entire application in one session. This form will NOT save. The SAVE button's only function is to submit the completed application form to the program office. Navigate the form (move from field to field) by hitting the tab button (if you hit the space bar all previously inputted data will be lost in cyberland!!) At the end of these instructions is the link to the Ferguson Fellowship Online Application. Please note that all applications must be completed using the RISE Programs Online Application. Applications submitted AFTER the deadline of January 31, 2016, 11:59PM EST will automatically be deleted from the database. Please note all applications are automatically dated and time stamped. If applying online poses a hardship, please contact our office during business hours before the closing date for an alternate submission method ( ). IMPORTANT: Be prepared to complete the application in one session (2 hours), you will NOT be able to save the form and return to complete later, however you will be given the option to PRINT the form upon saving. Have all of your documents readily available and saved in the final formats. Many of the fields are required. The below instructions will help you complete the application. Before opening the application link please review the instructions and the application at the end of the instructions) in detail. You will need to have the following information and electronic documents saved and accessible on the computer, you will be using, to upload into the application or copy and paste into the application. Uploaded files should be in the following format and cannot exceed 25 MB: Resume (PDF format): example: smith_joe_resume Unofficial Undergraduate Transcript (PDF format): example: smith_joe_undertranscript Unofficial Graduate Transcript (PDF format): example: smith_joe_transcript Have the following items completed and saved in a word document so you can cut and paste into the online application 1. The five (5) Short Answer Responses (maximum 250 words each response) 2. The Essay Questions #1 and #2 (both required maximum 500 words each essay)

2 Tooltips (hover your mouse over the question mark in the gray circle) will provide information on certain fields and questions. APPLICATION ACKNOWLEDGEMENT Section: Please type your full name in the field provided. Click Sign under the Signature Box. Use your cursor (or if you have a touch screen) sign your name in the box. Click Done, located below the signature box, when completed. 1) When you complete the application return to the top right column of the application and click Save Record; hitting Save Record will SUBMIT your application. If you forget to complete a section, hitting the Save Record button will notify you what required items are missing in the Record Save Checklist (right column). 2) Saving the Record may take a few seconds. Once completed you will be given the option to Close or Print. Please be prepared to print your application or change your print options and print to a PDF. 3) Again, you will NOT be able to save the form AND return to complete later. THE SAVE RECORD BUTTON SUBMITS COMPLETED APPLICATIONS TO THE FERGUSON FELLOWSHIP PROGRAM OFFICE. 4) For your tracking, you will receive the following automatic s (we recommend you save these s): A) A confirmation receipt upon submission of your application B) tification when your referee(s) have submitted a letter of recommendation to the Ferguson Fellowship program office. If you are ready to complete the Ferguson Fellowship Application_PLEASE RIGHT CLICK HERE TO BEGIN (Right click on the TEXT LINK and select Copy Hyperlink, then paste URL into one of the following Browsers: FireFox or Google CHROME). This link can also be found at This is NOT the Online Application this is a DOCUMENT

3 Application: Ferguson 2016 Application Instructions This application cannot be saved for later completion. Once you begin you must complete. The SAVE button SUBMITS COMPLETED APPLICATIONS to the program office. Applicant Information *Date of Application 10/22/2015 *Name First Middle Last *Date of Birth MM/DD/YYYY Local: Address * Address 2 (personal ) [email protected] *Phone: Local *Phone: Home Phone: Cell *Gender Female Male Other *Ethnicity Hispanic or Latino? (Other, please specify ethnicity) Other *Race (Please select the best description of your race) *Local: State *Local: Zip Code If requested, Please SPECIFY race details in the box below. *Citizenship Status U.S. Citizen Permanent Resident U.S. National *Primary Language Spoken at Home English Spanish or Spanish Creole 1/7

4 Chinese Tagalog French (including Patois, Cajun) Vietnamese German Korean Other *First generational college? *Have you ever received free or reduced price lunch benefits? *Pell Grant Eligible *I learned about the Ferguson Fellowship Program from: Permanent Residence *Address Address Line 1 Address Line 2 Education, Experience and Focus *College/University *Minority Serving Institution Historically Black Colleges and Universities (HBCU) Hispanic serving Asian serving Tribal Colleges and Universities Other Minority serving t Applicable *Student Classification Postbaccalaureate Graduate Year *Undergraduate Major Anthropology Biology/Biological Science Business Chemistry Communications Computer Science Economics Education English Engineering Geography Health Education Health Sciences History International Relations Journalism Mathematics *Permanent State *Permanent Zip Code 2/7

5 Marketing Neuroscience Nursing Pharmacy Psychology Political Science Pre Dentistry Pre Med Public Health Sociology Veterinary Medicine t Specified *Current Major Dental Veterinary Medicine Medicine Master of Public Health (MPH) Pharmacy Doctorate Public Health (PhD or DrPH) *All applicants must answer this question. If you are NOT pursuing a Master of Public Health, please select t Applicable. MPH majors please identify your area of concentration, select all that apply. t Applicable Biostatistics Child and Adolescent Health Community Health Education Disaster Management & Emergency Preparedness *My educational track Master of Public Health Other Master's Degree Doctorate Degree (e.g. PhD, DrPH) Professional Doctorate (e.g. MD, PharmD, DDS, DVM) *What is your career focus? Clinical Focus Public Health Focus Research Focus *What is your future career setting? *Anticipated Graduation Date MM/DD/YYYY *GPA Range 3.0 to to 4.0 *Current GPA 0.0 *Site Preferences CDC, Atlanta, GA Kennedy Krieger Institute/Johns Hopkins Medical Institutions, Baltimore, MD Housing Requests *I need housing for the orientation in Baltimore, MD *I need housing in Atlanta *I need housing in Baltimore 3/7

6 *I will need parking information for the summer training site (parking fees are not covered by the Program) *If you select the Kennedy Krieger Institute/Johns Hopkins Medical Institutions site, would you be willing to commute by train or personal transportation within the Baltimore Washington, DC metropolitan region for your research experience? Health Insurance and Emergency Information *Health Insurance Carrier (enter t Applicable if none) Policy Number Subscribers Name *Emergency Contact Name *Address for Emergency Contact Address Line 1 Address Line 2 *Phone: Emergency Contact *If accepted, will you require any special accommodations, e.g., accessible transportation? If you require special assistance, please describe the support you will need tes Name of personal assistant, if applicable *State for Emergency Contact Select your top 4 choices from these research areas if your preferred site is CD Emergency Preparedness Public Health Education Public Health Economics *Emergency Contact: Zip Code Epidemiology Laboratory Science Public Health Policy Public Health Informatics Public Health Communication Select your top 4 choices from these research areas if your preferred site is Ke Clinical Research Local Health Department Public Health Education (1) 4/7

7 Epidemiology (1) Laboratory Science (1) Pharmacy, Infectious Diseases State Health Department Short Answers 250 words maximum per question *Describe your past community service, leadership, and/or research experiences. tes *How do you anticipate participating in the Ferguson Fellowship will help your future career goals? tes *List any achievements (i.e., honors or awards) tes *How do you see the attainment of your career goals contributing to public health? tes *Describe how health disparities impact the prevention, treatment, and control of infectious diseases. tes Please complete a 500 word essay for each question below *ESSAY NUMBER 1: Which infectious disease(s) are you most interested in learning more about? (500 word maximum) tes *ESSAY NUMBER 2: Describe your ideal infectious diseases research project, include the public health problem to be addressed, methods and expected results. (500 word maximum) tes Curriculum Vitae or Resume *ATTACH FILE (PDF format) Choose File file chosen Up to 25 MB University Undergraduate Transcript Unofficial *ATTACH Unofficial University Undergraduate Transcript (PDF format); name must be on printed version PLEASE NOTE AN OFFICIAL UNDERGRADUATE TRANSCRIPT IS REQUIRED UPON ACCEPTANCE. Please ensure the transcript includes your name and the school name. Choose File file chosen 5/7

8 Up to 25 MB University Graduate Transcript Unofficial *ATTACH Unofficial University Graduate Transcript (PDF format) PLEASE NOTE AN OFFICIAL Graduate TRANSCRIPT IS REQUIRED UPON ACCEPTANCE.Please ensure the transcript includes your name and the school name. Choose File Up to 25 MB file chosen Letters of Recommendation Two letters of recommendation from faculty at your previous or current university are required. Upon submission (SAVE RECORD) of your application, an will automatically be sent to each Referee with instructions on how to submit a letter on your behalf. All letters must be uploaded on institutional letterhead using the electronic form provided to the referee. Deadline date for receipt of letters of recommendations is January 31, 2016, 11:59 PM. *Reference 1 Name First Middle Last *Referee 1 Institution/Organization *Reference 1 [email protected] *Referee 1 Phone *Reference 2 Name First Middle Last *Referee 2 Institution/Organization *Reference 2 [email protected] *Referee 2 Phone Consent to Survey Participation *I agree to be contacted to help evaluate the need for summer public health leadership programs. Participation in an end of summer evaluation will include a drawing for a gift card. Application Acknowledgement *Please type your full name and provide signature in the box using the cursor. By doing so you acknowledge that the information contained in 6/7

9 this application is true and accurate to the best of your knowledge and that information may be summarized and shared with the Federal Funding Agency, the Centers for Disease Control and Prevention. Name Full Name Signature To SUBMIT your application To SUBMIT your application, click 'SAVE RECORD'. By saving you will SUBMIT your application to the Program Office. 7/7