Vascular Biology Training Grant Application


If you have already applied to either the Clinical Cardiology and Cardiovascular Research Fellowship Program or the Physician-Scientist Fast-Track Training Program through the Department of Internal Medicine, you need not submit an additional application.  Your original application will be forwarded to us for consideration.

IMPORTANT:  Only citizens and permanent residents of the U.S. are eligible to apply, according to regulations of the National Institute of Health, the funding agency for this program.

Section 1: Personal Information

First Name: Middle Initial: Last Name:

DOB (mm/dd/yy):

Street Address: 
Street Address (cont.): 

City: State: Zip Code:

Phone Number (primary):  (secondary):

Fax Number: 

Email Address:

URL:

Are you a US Citizen?  Yes No
If not, are you a Permanent Resident?  Yes  No

REMINDER: Only citizens and permanent residents of the U.S. are eligible to apply, due to regulations of the National Institute of Health, the funding agency for this program.

Section 2: Education

Undergraduate Education

Institution:   Degree:

Dates To/From:  /     GPA in Major:

Overall GPA:

Graduate Education

Institution:    Degree:

Dates To/From:  /      GPA:

Medical Education

Institution:     Degree:

Dates To/From:   /     GPA:

Internship Information

Internship PGY-1 Location:   
Dates To/From: /

Residency Information

Residency PGY-2 Location: 
Dates To/From:  /

Residency PGY-3 Location:
Dates To/From:  /

Residency PGY-4 Location:
Dates To/From:  /

Fellowship Information

Fellowship PGY-3+ Location: 
Dates To/From:  /

ECFMG Information (If Applicable):  

National Board Exams/USMLE (please use 200 series scale )

Step #1 Date    Score

Step #2 Date    Score

Step #3 Date    Score

Section 3: Additional Information

Information you would like to include with your application
(i.e. Honors, Award, Organizations, Research Projects, Publications, etc.)

 

Future Career Plans/Goals

Which UVA faculty member(s) seem most aligned with your research interests?   

You may attach a CV here:  

By pressing the "Submit Application" button below, you signify that the information above is true and correct.

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Consistent with Federal and State law, the University does not discriminate in any of its programs, procedures or practices on the basis of age, color, disability, national or ethnic origin, political affiliation race, religion, sex (including pregnancy), sexual orientation, or veteran status. The University operates equal opportunity and affirmative action programs for faculty, staff, and students, including discriminatory harassment policies and procedures. The University of Virginia is an Equal Opportunity/Affirmative Action Employer.

The Office of Equal Opportunity Programs (Office of EOP) is responsible for the enforcement of the University's non-discrimination obligation. A faculty member, staff employee, or student having a complaint of prohibited discrimination may file a discrimination complaint with the Office of EOP subject to the standards and in accordance with the "University of Virginia Discrimination Complaint Procedures" with the Equal Opportunity Officer, Washington Hall, East Range, P. O. Box 400219, University of Virginia, Charlottesville, VA 22904, (434) 924-3200. Complaints are to be submitted in accordance with, and are subject to, the standards of the "University of Virginia Discrimination Complaint Procedures."

The University's Section 504, and American Disabilities Act Coordinator is Brad K. Holland, University Ombudsman/ADA Coordinator, (434) 924-7819 and the Title IX Coordinator is Brad K. Holland, Interim Director of Equal Opportunity Programs Office, (434) 924-3200. The mailing address for both is Washington Hall, East Range, P. O. Box 400219, University of Virginia, Charlottesville, VA 22904.
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