Fellowship Application

Fellowship Application

Instructions

Please complete the application and upload your CV.

Full Name (first and last)*

Department*

Email Address*

Phone Number*

Status (faculty rank, fellow, resident, etc.)*

Promotion Track (If Faculty)

Select or enter value

Question1:*

Why do you want to participate in this fellowship? How will it support achieving your professional goals?

Question 2:*

Describe the educational ledadership role you currently have or would like to have in the future.

Assignments in this fellowship include designing a curriculum (e.g., develop and present a plan for a curriculum of any size and scale for a designated group of learners) and a scholarly project (e.g., design a small-scale educational research or evaluation study with feedback and guidance from fellowship directors and peers). The focus of the scholarly projects should be education (e.g., learning, teaching) not a clinically related quality improvement project.

Question 3:*

What ideas do you have for a curriculum project to focus on during the fellowship?

Question 4:*

What ideas do you have for a scholarly project to focus on during this fellowship? List any potential collaborators or mentors.

Question 5:*

Describe how you will have time to participate given your busy schedule. On average, this will require 2.5 hours/week from the last week of August to May devoted to classroom seminars or assigned readings and preparation. Seminars will occur on Fridays every other week from 1-3:30PM.

*This Fellowship will receive CME credit.

File Upload*

Please upload your CV:

Drag and drop files here or

We will send an attestation form to your supervisor to approve your participation in this fellowship and your protected time to attend Friday seminars and complete project work.

Supervisor Email Address:*

Send me a copy of my responses

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