First Name (Given name):
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Last Name (Surname):
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Please provide the address at which you currently reside.
Street Address
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Country
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Is your permanent address different than the address provided above?
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Yes
No
Email Address
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Telephone Number
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Are you a U.S. citizen or permanent resident?
* must provide value
Yes
No
Country of citizenship
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In July 2024, will you be a predoctoral (not yet completed terminal degree; current PhD, DVM, MD, MBChB student) or postdoctoral (completed terminal degree within the last 6 years) candidate?
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Predoctoral Candidate Postdoctoral Candidate
Date doctoral/terminal degree received or expected (MM-DD-YYYY)
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Today M-D-Y Please visit http://fogartyfellows.org/apply/ for full eligibility criteria for U.S. candidates.
Date doctoral/terminal degree received or expected (MM-DD-YYYY)
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Today M-D-Y Please visit http://fogartyfellows.org/apply/ for full eligibility criteria for LMIC postdoctoral candidates.
What are your current credentials (DDS, DVM, MD, PhD, etc.)? Please provide all.
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What is the discipline/specialty of your most recent/current degree (public health, internal medicine, epidemiology, etc)?
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Allergy & Immunology Biostats/Epidemiology/Bioinformatics Cardiology Dermatology Environmental Health Genetics Geriatrics Health Economics Hematology Infectious Diseases Metabolism/Endocrinology/Nutrition Neurology Oncology Ophthalmology Pediatrics Psychiatry Rheumatology Surgery/Emergency Medicine/Trauma Other
Please specify discipline/specialty.
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What is your current professional title/position?
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What is your current department?
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What is your current institution?
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Provide a brief background on your education and training (specialty)
Please use the following format for your answer:
e.g. Trinity University: BS Biology 2005; Boston University: MD 5/2014; Indiana University: Internal Medicine Residency 6/2018; University of Washington: Infectious Diseases Fellowship (ongoing)
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e.g. Trinity University: BS Biology 2005; Boston University: MD 5/2014; Indiana University: Internal Medicine Residency 6/2018; University of Washington: Infectious Diseases Fellowship (ongoing)
With which U.S. Institution are you affiliated?
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University of Hawai'i University of Michigan University of Minnesota University of Washington Indiana University Other
Please specify the U.S. institution with which you are affiliated.
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To which research site are you applying (limit one)?
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Cameroon-University of Yaounde Ghana-Dodowa Health Research Center Ghana-Komfo Anokye Teaching Hospital Ghana-Korle Bu Teaching Hospital Ghana-Kwame Nkrumah University of Science and Technology Ghana-Navrongo Health Research Center Ghana-University of Ghana India-Jawaharlal Nehru University India-Manipal Academy of Higher Education Kenya-Kenya Medical Research Institute Kenya-Kenyatta National Hospital Kenya-Moi University Kenya-University of Nairobi Liberia-University of Liberia Nepal-Kathmandu University (Dhulikhel Hospital) Nepal-Nepal Cleft and Burn Center (Kirtipur Hospital) Peru-Asociación Civil Impacta Salud y Educación Peru-Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales Peru-Instituto Nacional de Ciencias Neurologicas Peru-Universidad Nacional Mayor de San Marcos Peru-Universidad Peruana Cayetano Heredia Thailand-Chiang Mai University Thailand-Chulalongkorn University Thailand-Mahidol University Thailand-Thai Red Cross AIDS Research Centre Uganda-Global Health Uganda Uganda-Mbarara University of Science and Technology Uganda-Makerere University (Infectious Diseases Institute) Uganda-Mulago Hospital Uganda-Uganda Cancer Institute
What is your skill level in the language of your proposed host country (note: language skills are not a requirement of our program)?
Native speaker Advanced Intermediate Beginner No experience
Yes
No
If you have been funded by a Fogarty Global Health Fellows/LAUNCH program previously, please contact Roopa Sriram ghfprgm@uw.edu for eligibility determination before proceeding
We look for opportunities to leverage other funding and resources, so please make sure to disclose any other sources (or potential sources) of funding that you may receive during your fellowship year.
Do you anticipate any potential co-funding for your fellowship year (e.g. T32 fellowship, institutional funding, in kind support, or other grants or fellowships to which you are applying)?
* must provide value
Yes
No
Please describe:
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Have you previously received an NIH Career Development or Research Grant (GRIP, K Award, R01) as Principle Investigator or Co-PI?
* must provide value
Yes
No
Please describe:
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Are you reapplying to the NPGH Consortium?
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Yes
No
If yes, please describe how this application is different from your previous submission.
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Title of research project
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Download the following Word document and upload completed essays below. Please upload essays as a Word document.
APPLICANT ESSAYS Upload your completed essays in Word document format (do not submit as a PDF ). Please note the word and page limits for each essay. Essays will not be reviewed if they are over the designated word or page limits or if they do not comply with formatting requirements.
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You may download and use the following Excel budget template or use your own budget template if you prefer.
TENTATIVE BUDGET
Upload a budget for your proposed study.
Note that funding is limited to $7,500 for U.S. pre-doctoral applicants and $10,000 for U.S. & LMIC post-doctoral applicants. If your budget is higher than the amount available, please indicate the source of additional funding.
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Download the following NIH Biosketch template and upload completed Biosketch below. Please upload Biosketch as a Word document.
NIH-STYLE BIOSKETCH
Upload an NIH-style biosketch (use the template provided above). For NIH Biosketch resources and instructions, please visit the NIH website: https://grants.nih.gov/grants/forms/biosketch.htm.
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ACADEMIC TRANSCRIPT
Upload your most recent transcript. Unofficial transcripts are acceptable.
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Enter the number of research publications that you have published or that are currently accepted/in press (do not include publications under review or in preparation)
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Enter the number of research publications that you currently have under review.
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Enter the combined number of conference presentations and abstracts that you have had accepted
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Please provide information below regarding your mentors. Letters of support can be uploaded here or emailed directly to ghfprgm@uw.edu.Two letters of recommendation are required. One letter should come from a mentor at a U.S. institution within our consortium and one letter from a mentor at the international partner site you are applying to. A third letter is optional and can come from another mentor or someone outside your mentorship team. No more than three letters of support should be submitted.
Note for LMIC Fellow Applicants : Letter from U.S. mentor should explicitly mention approval of the applicant's proposed U.S. short-term training plans.
U.S. Mentor Name
* must provide value
U.S. Mentor Affiliation
* must provide value
University of Hawai'i University of Michigan University of Minnesota University of Washington Indiana University
U.S. Mentor email address
* must provide value
U.S. Mentor NIH Biosketch
* must provide value
Biosketch Template: https://grants.nih.gov/grants/forms/biosketch.htm
Letter of Support
* must provide value
I have a letter of support from my U.S. mentor to upload
My mentor will email a letter of support to ghfprgm@uw.edu
Note for LMIC Fellow Applicants: Letter from U.S. mentor should explicitly mention approval of the applicant's proposed U.S. short-term training plans.
Upload U.S. Mentor Letter of Support
Research Site Mentor Name
* must provide value
Research Site Mentor Affiliation
* must provide value
Cameroon-University of Yaounde Ghana-Dodowa Health Research Center Ghana-Komfo Anokye Teaching Hospital Ghana-Korle Bu Teaching Hospital Ghana-Kwame Nkrumah University of Science and Technology Ghana-Navrongo Health Research Center Ghana-University of Ghana India-Jawaharlal Nehru University India-Manipal Academy of Higher Education Kenya-Kenya Medical Research Institute Kenya-Kenyatta National Hospital Kenya-Moi University Kenya-University of Nairobi Liberia-University of Liberia Nepal-Kathmandu University (Dhulikhel Hospital) Nepal-Nepal Cleft and Burn Center (Kirtipur Hospital) Peru-Asociación Civil Impacta Salud y Educación Peru-Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales Peru-Instituto Nacional de Ciencias Neurologicas Peru-Universidad Nacional Mayor de San Marcos Peru-Universidad Peruana Cayetano Heredia Thailand-Chiang Mai University Thailand-Chulalongkorn University Thailand-Mahidol University Thailand-Thai Red Cross AIDS Research Centre Uganda-Global Health Uganda Uganda-Mbarara University of Science and Technology Uganda-Makerere University (Infectious Diseases Institute) Uganda-Mulago Hospital Uganda-Uganda Cancer Institute Other
Please specify your research site mentor's affiliation.
Research Site Mentor email address
* must provide value
Research Site Mentor NIH Biosketch
* must provide value
Biosketch Template: https://grants.nih.gov/grants/forms/biosketch.htm
Letter of support
* must provide value
I have a letter of support from my Research Site Mentor to upload
My mentor will email a letter of support to ghfprgm@uw.edu
Upload Research Site Mentor Letter of Support
Do you have an additional letter of support to upload? (optional)
A third letter is optional and can come from another mentor or someone outside your mentorship team. Note that no more than three letters of support should be submitted in total.
* must provide value
Yes
No
Provide the full name, affiliation, and email address for the individual providing your optional letter of support
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Enter the names, affiliations, and email addresses of any other members of your Mentor Team
I grant permission to the Fogarty Program to contact these individuals about my application and my previous professional experiences and conduct.
* must provide value
Yes
No
Upload a photo of yourself in .png or .jpg format.
This will be used for a trainee biography book distributed at orientation.
* must provide value
Please note the information provided in this section is used solely to track the effectiveness of our recruiting efforts and ensure we consider the needs of all our candidates. We do not discriminate on the basis of race, color, creed, religion, national origin, citizenship, sex, pregnancy, age, marital status, sexual orientation, gender identity or expression, genetic information, disability, or veteran status.
Note: This information will not be included in the review of your application.
How did you hear about the program?
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Email from mentor/colleague Alumnus or current fellow Internet search Website Dean or professor Conference Other
If other, please describe:
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Gender
* must provide value
Male Female Non-binary Prefer to self-describe Prefer not to answer
Gender, self-describe
* must provide value
Birth Date
* must provide value
Today M-D-Y
American Indian or Alaska Native Asian Black or African American Hispanic or Latinx Native Hawaiian or Other Pacific Islander White Other; please specify Prefer not to answer
Underrepresented populations in the biomedical, clinical, behavioral and social sciences
The NIH Fogarty International Center (FIC) is interested in better understanding and promoting diversity, and they have requested we collect additional information regarding our program applicants' race, ethnicity, and additional factors regarding underrepresented populations in research.
The following questions are in relation to NOT-OD-20-031 where the NIH has identified certain groups of people who have been historically underrepresented populations in the biomedical, clinical, behavioral and social sciences.
Please indicate how you identify with the following categories.
Individuals from racial and ethnic groups that have been shown by the National Science Foundation to be underrepresented in health-related sciences on a national basis (see data and the report Women, Minorities, and Persons with Disabilities in Science and Engineering ). The following racial and ethnic groups have been shown to be underrepresented in biomedical research: Blacks or African Americans, Hispanics or Latinos, American Indians or Alaska Natives, Native Hawaiians and other Pacific Islanders. In addition, it is recognized that underrepresentation can vary from setting to setting; individuals from racial or ethnic groups that can be demonstrated convincingly to be underrepresented by the grantee institution should be encouraged to participate in NIH programs to enhance diversity. For more information on racial and ethnic categories and definitions, see the OMB Revisions to the Standards for Classification of Federal Data on Race and Ethnicity .
* must provide value
Yes No Prefer not to answer
Yes No Prefer not to answer
Yes No Prefer not to answer
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