Please complete the following application for the 2012-2013 Boston SFP.
Paired Project Note: Applicants applying as a pair should complete individual applications. Answers to questions in the Project Information section and relating to faculty and community site mentors can be identical; all other answers should be individual.
(*Required fields)
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| *First name: |
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| *Last name: |
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| *Address: |
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| Address 2: |
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| *City: |
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| *State: |
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| *Zip: |
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| *Primary phone: |
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| *Preferred Email: |
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| *Will you be enrolled in a degree-granting program through April 2013? |
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| *What year in your degree program will you be during the 2012-13 academic year? |
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*When is your expected graduation date? |
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| For joint applications, please list your project partner's name: |
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| *School: |
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| Other School: |
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| *Discipline: |
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| Other discipline: |
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*Fellows are expected to participate in Fellowship activities throughout the year (April 2012-April 2013). Will you have significant clinical responsibility during the Fellowship year that may interfere with your ability to participate in the Fellowship? |
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| If yes, please describe: |
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*Please indicate any times you anticipate being out of the area and/or unable to participate in Fellowship activities for reasons other than those listed above: |
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| Project Information |
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| *1. Target Population for your proposed community service project, including demographic information. (Suggested Word Count 100) |
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| *2. Proposed Community Agency/Agencies (If a community agency has not yet been identified, please type TBD): |
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| *3. Describe the community need for your project and how your project will support local and national health priorities. (Suggested Word Count 150) |
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*4. Please describe your proposed community service project, including project goals and the actions you will take to meet these goals. (Suggested Word Count 350)
NOTE:
Applicants proposing to sustain an existing project supported by the Schweitzer Fellowship should explain why they are choosing to continue this particular project and the ways in which the project will be expanded.
Applicants applying as a pair should discuss why the project needs to be led by two people in order to succeed (as opposed to a project led by an individual). Detail the role of each partner. |
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| *5. What is the time frame for your project? Please consult application guidelines for specific program start and stop dates. (Suggested Word Count 150) |
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*6. Describe the avenues you will explore to sustain the project beyond your time as a Fellow. (Suggested Word Count 200) |
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| *7. How will you evaluate the project to determine whether your goals were met? (Suggested Word Count 200) |
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| Personal and Professional Information as it Relates to the Fellowship Activities |
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| *8. What is your motivation for applying to the Schweitzer Fellowship? Please consider the community service project, participation in the Fellowship activities and being part of a multidisciplinary group. (Suggested Word Count 200) |
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| *9. Considering that there are many different types of community service projects a Fellow could design, what inspired you to develop your particular project idea? (Suggested Word Count 200) |
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*10. Personal Statement
Please discuss the following: (Suggested Word Count 600)
- Ways in which your participation as a Schweitzer Fellow would be meaningful to your personal and professional development.
- Skills and experiences you will bring to the Fellowship
- What it might mean for you to belong to an alumni network of “Fellows for Life.”
- Any unique, personally important, and/or challenging factors in your background, and how they have influenced your goals and preparation for your career.
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| References and Resume |
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| *11. Please list the contact information for three references. At least one reference should be a faculty member from your school who could serve as your Academic Mentor for the Schweitzer Fellowship. For each reference, describe your relationship in one sentence and include contact information such as telephone number and email address. |
Reference 1/Proposed Faculty Mentor:
Reference 2:
Reference 3:
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*12. Please list someone at your proposed site who could serve as a Site Mentor or who has been your site contact. Include telephone number and email address. If a possible Site Mentor or contact has not yet been identified, please type TBD. |
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*13. Please paste your resume into the text box below and format it the best you can.
Due to the volume of applications, separate attachments cannot be accepted. |
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| Letters of Recommendation |
Please check your local program’s application guidelines for specific requirements regarding letters of recommendation. |
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