STUDENT INFORMATION
Student Name (Last, First Middle): /
Student ID #:
Student Email address: / Student Phone: ( ) -
Department: / Degree Objective: Ph.D.
Stanley Behrens Fellows in MedicineAward Package: Award package will consist of $20,000and includes:
•Research support through the PI’s lab focused on the student’s area of research ($13,000)
•Professional Development expenditure allocation of $2,000.
•Summer stipend bonus of $5,000 to be paid directly to the student. This stipend bonus is not to replace any existing stipend but is intended to be in addition to the existing stipend.
Successful nominees must meet the following criteria:
  • Nominee has a minimum UCI GPA of 3.7 in graduate level coursework–(y/n)
  • Nominee is in 3rd, 4th, or 5th year of study–(y/n)
  • Nominee is a SOM Ph.D. student– (y/n)
  • Nominees must be available for interview May 3–(y/n)
Students will be selected based on their academic excellence, scientific promise, scholarly/professional potential, community and university service and other notable characteristics that make the nominee exceptional.
Nomination Submission Instructions: Each SOM department may decide the number of nominees that they wish to submit.The nomination packages must be submitted by the department CAO or MSO via e-mail by5 pmonFriday, April 10, 2017to Leora Fellus () in the SOM Office of Graduate Studies.Incomplete applications will not be accepted.
  • The nomination package should consist of a single PDF file containing the following scanned items in order:
  • A completed and signed Stanley Behrens Fellows in MedicineDepartmentNomination Form
  • A completed and signedStanley Behrens Fellows in MedicineInformation Sheet
  • The student’s CV
  • Aconfidential letter of recommendation fromthe student’s faculty advisor/PI.
  • Each nomination packet must be saved in the following way: SBFM2017-DEPARTMENT NAME-NOMINEE LAST NAME-NOMINEE FIRST NAME. (For example, SBFM2017-MYDEPARTMENT-ANTEATER-PETER)

REQUIRED SIGNATURES
Faculty Advisor /PI Name / Signature / Date
Department Chair Name / Signature / Date