application

Post-Doctoral Research Training Program in Neurodevelopmental Disorders

Please complete (type) all fields of this application, print a hard copy to sign, and submit with a copy of your curriculum vitae and three letters of recommendation (in signed, sealed envelopes). If you choose, you may also submit up to three publications, papers, or abstracts.

Feel free to scan your signed, completed application and submit your materials (except letters of recommendation) via email to:

Along with your application materials, please submit a brief personal statement (3-5 pages) summarizing: 1) why you are pursuing post-doctoral training; 2) your research interests in neurodevelopmental disorders; 3) your professional goals; and 4) your objectives for this post-doctoral training experience.

All applications received by May 1st, 2013 will be considered.

APPLICANT ELIGIBILITY REQUIREMENTS

Trainees are required to pursue their research training on a full-time basis, devoting at least 40 hours per week to the program. Within the 40 hours per week training period, research trainees in clinical areas must devote their time to the proposed research training and must confine clinical duties to those that are an integral part of the research training experience.

Citizenship. To be appointed to a training position supported by an NRSA research training grant, an individual must be a citizen or noncitizen national of the United States or must have been lawfully admitted for permanent residence (i.e., in possession of a currently valid Alien Registration Receipt Card I-551, or must be in possession of other legal verification of such status). Noncitizen nationals are generally persons born in outlying possessions of the United States (e.g., American Samoa and Swains Island). Individuals on temporary or student visas are not eligible.

Postdoctoral Trainees. Postdoctoral trainees must have received, as of the beginning date of the NRSA appointment, a Ph.D., M.D. or comparable doctoral degree from an accredited domestic or foreign institution. Eligible doctoral degrees include, but are not limited to, the following: D.D.S., D.M.D., D.O., D.V.M., O.D., D.P.M., Sc.D., Eng.D., Dr. P.H., D.N.Sc., D. Pharm., D.S.W., and Psy.D. Documentation by an authorized official of the degree-granting institution certifying all degree requirements have been met prior to the beginning date of training is acceptable.

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SECTION I: BACKGROUND INFORMATION

Name (Last, First, Middle Initial)

Mailing Address


Phone ()

Permanent Home Address (if different from above)


Phone ()

E-mail address

FAX ()

Gender Male Female

Birthdate

Birthplace (city, state, country)

Citizenship

U.S.non-citizen national of the United States?

permanent US resident eligible to work in the United States?

Other (please specify)

Social Security #

To meet NIH reporting requirements, please complete Part 1 and Part 2 below:

Part 1. Ethnic Category
Hispanic or Latino
Not Hispanic or Latino
Unknown or do not wish to report

Part 2. Racial Categories
American Indian/Alaska Native
Asian
Native American or other Pacific Islander
Black or African American
White
More than one race
Unknown or do not wish to report

How did you hear about this training program?

SECTION II: ACADEMIC TRAINING

Education: List all colleges, universities, graduate, and professional schools you have attended.

Institution / Location (city,
state, country) / Focus of
Study / Degree awarded / Graduation
Date

References. Identify the persons you have asked to complete recommendation letters.

1.
2.
3.

Have you ever had a postdoctoral research fellowship?
Yes No

Dates Begin to End / Funding Source / Research Focus
SECTION III: Current info/Research interest

What is your current position and place of employment or study?

Current position / Place of employment /study

What type of research would you like to do during this Postdoctoral Training Program?

What Training Program faculty member(s) would you most like to work with? (Click here to view faculty list.)

1.
2.
3.

SECTION IV: FOR Ph.D. APPLICANTS ONLY

Title of your dissertation

Status in doctoral program (If not complete, anticipated graduation date)

SECTION V: FOR ALL APPLICANTS
I certify that the information in this application is complete and correct and understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment, or appropriate disciplinary action.
______Signature,
date

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Mail application to:

Program Coordinator

Carolina Institute for Developmental Disabilities

UNC - Chapel Hill

101 Renee Lynne Ct

Carrboro, NC 27510

United States

Phone: (919) 843-8641

Fax: (919) 966-7080