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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