HARVARD SCHOOL OF PUBLIC HEALTH APPLICATION FOR …
Application for Infectious Disease Epidemiology Training
pre-doctoral fellowship
Name: ______________________________________________________________________
Present Address: _____________________________________________________________
Permanent Address: _________________________________________________________
Telephone: _________________________________ Date of Birth: __________________
Place of Birth: _______________________________________________________________
Racial/Ethnic Code (optional – please select all that apply): ___________________
1. Asian / Asian-American 4. Native American / Alaska Native
2. Black / African-American 5. Native Hawaiian or Pacific Islander
3. Hispanic / Latino 6. White
College(s) Attended Dates Degree
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Graduate School Dates Degree
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Department/Program in HSPH ________________________________________________
Degree sought (ScD, DPH, PhD) ______________________________________________
If already an HSPH Student:
Year in Program _______________ Advisor ______________________________________
Please include the following:
• Statement of research interests and career goals (maximum 2 pages)
• Curriculum vitae
• Two Letters of Reference (if you are already an HSPH Student, at least one of these should be from your advisor or a faculty member of your current program)
• Copies of all college & graduate school transcripts.
• If you are already an HSPH Student, provide a copy of a letter to the HSPH Registrar, granting access to your academic file
Complete applications should be submitted to Zennon Black at zblack@hsph.harvard.edu. In the subject line please put “Infectious Disease Epidemiology Pre-doctoral Fellowship.”
For more information contact Zennon Black, Sr. Administrative & Training Grant Coordinator, at:
617-432-1050
zblack@hsph.harvard.edu
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