2016-2017 Application for

LMIC-National Doctoral and Postdoctoral Candidates

Due November 1, 2015

DIRECTIONS:

Applicants are required to submit a two–page research proposal, as well as supplemental materials around their experience and planned mentorship. Candidatesare expected to have spent a significant amount of time preparing this application with the guidance of amentor affiliated with the site.

Note: Fogarty International Center has mandated that 80% of fellowship funding must go to HIV-related research activities so, where possible, applicants in high-prevalence settings should consider how HIV might relate to their work.

A. Email your complete application as a single PDF file to

B. Your mentors/advisors will email their letters of recommendation to

ApplicantContactInformation

FirstName: ______MiddleName: ______LastName: ______

Emailaddress: ______Skype ID: ______

Current Address: ______

City:Provence:Country:______

General details about proposal

LMIC candidates are invited to apply to work at established UJMT Consortium sites in one of the nine countries listed below. Candidates will need to be a citizen of the country selected.

Africa: Ghana, Malawi, South Africa, Uganda, Zambia

Asia: China, India

LatinAmerica: Argentina, Peru

Please indicate the country of your nationality and proposed fellowship work: ______

Passport #:______

Current Academic Institution: ______

Current Academic Department: ______

Current Position Title: ______

Undergraduate Institution: ______grad year______

Master’s Institution: ______grad year______

Medical or Doctoral Institution: ______grad year______

General details about proposal

HowdidyoulearnabouttheUJMTFogartyGlobalHealthFellowsProgram?
Area of research interest
Proposed LMIC training site (institution name):
Mentor at LMIC training site
Mentor at U.S. based institution, if applicable
Letter of recommendation from LMIC mentor is included? / Yes____ No____
Research project you intend to work on (attach the project methodology, IRB approval # and dates, PI biosketch, describe your role)
Original research proposal title (attach a 2 page research proposal

Required Letters of Recommendation (LOR)

Recommendations are to be provided separately, and emailed by the author to

  1. Prior/currentresearchmentor:

Institution
Title
Email:
  1. LMICbased UJMT FGHFmentor

Institution
Title
Email:
  1. If applicable, a letter from your department chair addressing career trajectory which can include comments on your faculty status. Will you include this or a comparable LOR?
/ Yes____ No____
Name
Title
Email:

Award requested (check one)

_____Full award (includes stipend, research and travel)

_____Research and travel only

_____Other: ______

Proposed appointment dates of 11-month traineeship: ______

(Note: Fellows are required to work a minimum of 36 hours per week on their research for 11 months)

Title of other training program (current or in the last 12-24 months): ______

Program Director: ______

Email address: ______

Demographics

Gender:__ Male

__ Female

__ Prefer not to answer

Ethnic Category:__ Hispanic or Latino

__ Not Hispanic or Latino

__ Prefer not to answer

Racial Category:__ Asian

__ African

__ White

__ More than One Race

__ Prefer not to answer

INSTRUCTIONS: PLEASE READ CAREFULLY

All components should be single-spaced, with 0.5” margins, and in Arial 11 point font. The page limit for each section are specified below

  1. Research Proposal (2 pages)

It is expected that applicants review the proposed research design extensively with their primary mentor

  1. Specific Aims
  2. Research Plan (overview)
  3. Significance
  4. Innovation
  5. Approach
  6. Timeline for proposed scope of work
  7. Human Subjects (describe the IRB process and timeline for approval)
  8. References should be included in the two page limit, if possible- font can be 9pt
  1. Budget and budget justification, up to $10,000 for LMICtrainees(1 page)
  1. Statement of career goals (1 page)
  1. Plan for mentorship over the Fogarty year (1 page)
  1. NIH Biosketch (

Pay close attention to formatting- an ill -formatted biosketch reflects poorly on your application.

  1. Two to three letters of recommendation emailed directly to
  • Required: research mentor letter (previous research)
  • Required: International site letter from the site mentor or PI confirming prior communication with them about their commitment to work with you. If your research mentor is based overseas full time then this statement would be included in the research mentor letter
  • If applicable, a letter from asupervisoraddressing career trajectory which can include comments on your future employment status