Fellowship Application

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Scope and Purpose of the Pfizer-CGH Fellowships in Infectious Disease

To create opportunities for international researchers to come to UVa and for UVa researchers to go to collaborating sites abroad.

To ameliorate the diseases of poverty through training for promising university research or clinical personnel who are committed to building relevant programs among collaborating institutions.

To foster collaborative relationships between UVa and international faculty.

To support research, work, and teaching focused on ameliorating the diseases of poverty.

Instructions

Please complete the following application. Email globalhealth@virginia.edu with any questions.

Personal Information
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Name*

Employing University or Institution*

Street Address*

City*

State or Province

Zip or Postal Code:*

Country*

Office and Cell Phone:*

Email Address*

Additional Comments

Date of birth?*

City and Country of birth>*

Citizenship?*

Gender:

M F

Marital Status:

Married Single

Children:

Proposal Information
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Institutional Address:*

Collaborating Mentor:*

Position:*

Contact Information:*

Research Interests:*

UVA Mentor:*

Position:*

Contact Information:*

Research Interests: *

Desired date of fellowship?*

Descriptive Project Title

Project Narrative to include the following:

Background
Rationale
Hypothesis
Methodology
Expected Outcomes
References

No more than 4 single spaced pages.

In the field provided, please upload your project narrative.

In the field provided, please upload your CV

In the field provided, please upload a budget of anticipated expenses including airfare, additional travel, visa fees, vaccines and medical expenses, living expenses and any anticipated project expenese.

In the field provided, please upload a letter of support from your departmental chair.

Please be aware that, In addition, if your research involves human subjects, you must apply for either HIC (Human Investigation Committee ) or IRB (Internal Review Board) approval.

Educational Information
______________________________________________

Undergraduate College/University:

Degree and Date:

Graduate College/University:

Degree and Date:

University of Virginia Health System

Personal Information ______________________________________________

Proposal Information ______________________________________________

Educational Information ______________________________________________

Personal Information
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Proposal Information
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Educational Information
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