Application for Area of Concentration in Global Health And

OFFICE OF INTERNATIONAL ACTIVITIES UNC SCHOOL OF MEDICINE APPLICATION FOR AREA OF CONCENTRATION IN GLOBAL HEALTH AND GLOBAL HEALTH SCHOLARS PROGRAM FOR UNC/H RESIDENT PHYSICIANS

This application is for residents applying to both the OIA Concentration in Global Health and the Global Health Scholars Program. Please visit the OIA website for a full description of requirements for these OIA-GME co-sponsored programs. To apply, trainees must have at least two years of postgraduate training time remaining, be in good academic standing and have the approval of their Program Director.**

Timeline: Applications are due on January 15th and selected by March 1st for a program start date of July 1st of the same year.

Application Instructions: All applications must be received electronically (c/o [email protected]) by January 15th, 2016 (LOR for AOC or Global Health Scholars program for given resident should be emailed directly, ATTN: Shay Slifko.) ALL applicants must complete Section 1. Section 2 should only be filled out by UNC Global Health Scholars Program applicants.

Applicants for the Concentration in Global Health must submit the following:  Section 1 of the application  Current curriculum vitae (CV)  One letter from residency Program Director OR designated faculty contact for global health attesting that the applicant is in good academic standing and has permission to enroll in the UNC Area of Concentration. There should also be a commitment to support in identifying a departmental faculty member to supervise the longitudinal project.

Applicants for the Global Health Scholars Program must submit the following:  Section 1 and 2 of the application  Current curriculum vitae (CV)  One letter from residency Program Director OR designated faculty contact for global health attesting that the applicant is in good academic standing and has permission to enroll in the Global Health Scholars Program. There should also be a commitment to support in identifying a departmental faculty member to supervise the longitudinal project and the letter should specifically comment on the trainee’s leadership and scholarly potential, ability to thrive in this mentored, but self- dedicated program, and any prior global health endeavors of note that have benefitted the department or UNC/Chapel Hill.

**Exceptions to the two year stipulation may be considered on a case by case basis for advanced trainees e.g.- Those who have already completed residency and are in fellowship training or preventive medicine residency.**

July 2015 If you have any questions about the application, please contact the OIA Program Manager, Shay Slifko at [email protected]

Section 1

PERSONAL INFORMATION

Applicant name: Permanent mailing address: Institutional Email: Alternate Email: Phone: Pager: Country of Citizenship: Languages Spoken Fluently: Training program: UNC Program Director: UNC clinical department: Anticipated date for completion of residency/fellowship program: Current Training Year (during 2015-2016):

Does your department have a Global Health Track/Pathway/Area of Concentration? Yes/no If yes, are you in it? Yes No

Have you had prior global health educational experiences (i.e. more than personal travel)? Yes No

If yes, please describe (location, organization, year(s) of duration, and what you did – e.g. clinical experience, research, community health, any leadership role?)

What do you hope to gain through the AOC in global health? (Skip this question if you are only applying to the GHSP)

Flexibility and adaptability are necessary when working in an international setting that may be resourced differently than what you may be accustomed to. Please describe a personal example of when you were able to demonstrate flexibility or cultural sensitivity when you experienced ethical or professional pressures.

By my electronic signature below, I authorize the Office of International Activities Scholarship Selection Committee to query the Residency/Fellowship Program Director and UNC’s Office of Graduate Medical Education about my standing in the program. I give my permission for the

July 2015 Committee to review all materials pertinent to my application for this scholarship. I also agree to purchase the required travel insurance providing repatriation and medical evacuation for a period covering the duration of my travel abroad, to register with the UNC Global Travel registry and to complete all other GME paperwork and processes involved for UNC resident physicians traveling. I also understand that I must satisfy all other requirements from my training program, parent clinical department, and/or Office of Graduate Medical Education.

______Signature Date

July 2015 Section 2 (for trainees applying to the GH Scholars Program)

Be sure to complete both Section 1 and Section 2.

1. Statement of Purpose: Describe your experience, area of interest, and your future career goals in global health. This can include work/volunteer international experiences, academic coursework, global public health programming or global health-related research. You should explicitly describe how this program will help you achieve your career goals. (maximum length of 2 pages – 12 pt. font, single space for all answers)

2. Global Health Project Proposal: Applicants are encouraged to include a brief outline of a potential longitudinal project, including sections on background, methods for investigation or objectives, a work plan, and outcomes. (maximum length of 1 page)

3. Departmental Global Health Mentor Name and Contact Information: Include a description on mentor’s involvement in global health (maximum length of 1 page)

July 2015