HIGHER Overseas Fellowships in Global Health Research



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** Please Note: for an application to be considered every field is required**

Applicant’s Name :

Last, First Middle

Preferred First Name (if different from First Name above)

Present Address:

____________________________________________Street Apartment Number – do not use P.O. Box

City State Zip Code

School/Institution:

Telephone (with area code)

Daytime

E-mail Address:

Permanent Address (if different than above)

___________________________________________________________________ Street Apartment Number – do not use P.O. Box

City State Zip Code

Date of Birth:

(MM/DD/YYYY)

Are you a U.S. citizen or permanent U.S. resident?

_____________________________________________

Current Education

Primary Health Professions Academic Institution and degree program(s):

Institution:____________________________________

Program:_____________________________________

R. Palmer Beasley Travel Award in International Research

Year in training:_______________________________

Anticipated date of graduation for each degree: ____________________________________________

Prior Education

Undergraduate Academic Institution:

Dates Attended:____________________________

Degrees & Field of Study: ____________________

Graduation Date: ___________________________

Graduate Academic Institute:

Dates Attended: ____________________________

Degrees & Field of Study: ____________________

Graduation Date: ___________________________

Letters of Support

(Recommendation letters to be provided separately – please see Application Guidelines page for specific instructions)

Name of Sponsoring Mentor/Advisor from Home Institution: ____________________________________________

Title: _______________________________________

Telephone (with area code): _______________________________________

E-Mail: ________________________________________________________________________

(The committed involvement of an academic mentor/advisor from the student’s home institution is an integral and required part of the program, both prior to, during, and after the period. Provide letter information below).

Name of Preceptor in oversea country: ____________________________________________Title: _______________________________________

Telephone (with area code): _______________________________________

E-Mail: ________________________________________________________________________

Research Experience

Prior research experience would be helpful but is not required for consideration for the program. If you have had formal research experience (such as long term undergraduate electives or summer programs), please lists the institution, project, and mentor, and describes the project and your role in it, demonstrating your scientific understanding of the work. List any research related publications. Please confine your answer within the space provided below (at least 10 font size)

Previous Foreign Experience related to academic studies, health care or volunteer work (please indicate duration of program)Please confine your answer within the space below (at least 10 font size)

Major Current Extracurricular Interests and Activities (include activities related to international health)

Personal Statement/Research Proposal: In the space provided, please state why you are interested in a research training experience abroad and what the goals you would like to achieve for this overseas research experience and how your career goals relate to future global health. Please confine your personal statement within the space below and use at least 10 font size.

Application Guidelines

The R. Palmer Beasley, M.D. Travel Award in International Research is established as a permanent endowment. Distributions from the endowment will be used for the benefit of the University of Texas School of Public Health (UTSPH). Funds will be used to support travel cost of SPH students working on important public health issues in a low/middle income country of Asia, Africa, or Latin America. Funds can also be used to support travel costs of graduate students, post-doctoral students or junior faculty from low/middle income countries to come to the U.S. to work with SPH faculty. This is an opportunity for highly motivated individuals to experience mentored research and practicum training at funded research centers or institutions in low/middle income countries.

Eligibility

• A strong interest in, and potential for, a career in international research activities in low/middle income countries.

• Support of your advisor or committed mentor.

• A commitment to pursue international research training.

Application Procedures

In order to apply to the program each applicant’s file must contain the following:

1) Application: Please complete the application.

Applications should be submitted electronically to:

R. Palmer Beasley, M.D. Travel Award Silvia.P.Santiago@uth.tmc.edu

2) Mentor’s/Advisor’s Letter of Recommendation:

To be completed by a faculty member who will, upon your acceptance into the program, serve as your home institution mentor or advisor both during and after the training period abroad. Letter of recommendation should be e-mailed to: Silvia.P.Santiago@uth.tmc.edu

The letter should include:

• Full name of student applicant

• Agreement to act as mentor or advisor to the applicant upon acceptance both during and after the training period abroad, including a statement of how their academic interests interface with those of the applicant and how they expect to help the applicant further develop those interests after his/her overseas training, and

• An evaluation of the applicant’s qualifications (to include academic performance, problem solving skills, coping skills ability for international research, ability to live abroad).

3) Transcript:

Students are responsible for arranging a copy of their current school transcript to be mailed. For UTSPH students a copy of your transcripts can be requested from Silvia P. Santiago. Silvia.P.Santiago@uth.tmc.edu to be included in the packet.

Silvia P. Santiago

Student Affairs Office

1200 Pressler RAS 231

Houston, TX 77030

Tel 713-500-9025

This is a self-managed application. You are responsible for ensuring that the above listed documents are submitted by March 15, 2014 in order for your application to be considered complete.

Timing

March 15, 2014 – Application Deadline

Applications that are not received along with letters by 5 PM March 14, 2014 will not be considered.

April 15, 2014 Program Selection Conference

Applicants will be informed of Results of Initial Review. You will be informed of the results of the initial application review. Selected students are expected to attend the New Trainee Orientation Program.

June 1st, 2014 through May 31st, 2015 Dates during travel should be completed.

Add something about the number of awards available, and the $ amount for the award.

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