LMIC-National Doctoral and Postdoctoral Candidates

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. Candidates are expected to have spent a significant amount of time preparing this application with the guidance of a mentor 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 [email protected] B. Your mentors/advisors will email their letters of recommendation to [email protected]

Applicant Contact Information

First Name: ______Middle Name: ______Last Name: ______

Email address: ______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 Latin America: 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 How did you learn about the UJMT Fogarty Global Health Fellows Program?

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 Yes____ No____ mentor is included? 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 [email protected]

1. Prior/current research mentor:

Institution Title Email: 2. LMIC based UJMT FGHF mentor Institution Title Email: 3. If applicable, a letter from your department Yes____ No____ chair addressing career trajectory which can include comments on your faculty status. Will you include this or a comparable LOR? 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 i. Specific Aims ii. Research Plan (overview) a. Significance b. Innovation c. Approach iii. Timeline for proposed scope of work iv. Human Subjects (describe the IRB process and timeline for approval) v. References should be included in the two page limit, if possible- font can be 9pt

2. Budget and budget justification, up to $10,000 for LMIC trainees (1 page)

3. Statement of career goals (1 page)

4. Plan for mentorship over the Fogarty year (1 page)

5. NIH Biosketch (http://grants.nih.gov/grants/funding/phs398/phs398.html) Pay close attention to formatting- an ill -formatted biosketch reflects poorly on your application.

6. Two to three letters of recommendation emailed directly to [email protected]  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 a supervisor addressing career trajectory which can include comments on your future employment status