Fordham University            The Jesuit University of New York
 


 
Application for the
Fordham University
HIV Prevention Research Ethics Training Institute

July 7 – 17, 2013
At Fordham University Center for Ethics Education, New York City
Funded by the National Institutes of Health, National Institute on Drug Abuse
Director, Celia B. Fisher, Ph.D.

Applications must be received by March 8, 2013* 
*To request an extension due to weather events or other extraordinary circumstances, please e-mail fisher@fordham.edu

Applicants will be notified of award decisions by April 12, 2013

After submitting the online application form please email EthicsInst@Fordham.edu to confirm receipt


First Name
Middle Initial
Last Name
Address Line 1
Address Line 2
City
State
Zip Code
Country
Home Phone - -
Work Phone - -
Cell Phone Number - -
Email Address
Date of Birth (MM/DD/YY)
Do you consider yourself Hispanic or Latino?

 

Which of the following best describes you?







 

Do you currently meet requirements to receive NIH funding? (i.e., U.S. citizen, permanent resident, VISA)

 
Education and employment
Highest Degree (PhD, MD)
and Year Conferred
Highest Degree Institution
Discipline of Highest Degree
All Other Degrees
and Years Conferred
Current Title/Position
Institution
Department
Address 1
Address 2
City
State
Zip Code
research and Scholarship
Number of Peer-Reviewed Publications
Number of First-Authored Peer-Reivewed Publications  
Number of Federally-Funded Grants Awarded (PI or Co-PI)  
Recommendations
Name of First Recommender
(Home Institution)
First Recommender Role
(e.g., post-doctoral supervisor, department chair)
First Recommender Institution
First Recommender E-mail Address
Name of Second Recommender
Second Recommender Institution
Second Recommender E-mail Address
additional materials
An official transcript of highest degree earned will be forwarded from:
(Institution)

Transcripts should be e-mailed (ethicsinst@fordham.edu) or mailed to:
HIV Prevention Research Ethics Training Institute
441 East Fordham Road, Dealy 226
Bronx, NY 10458
Fellows will be matched with mentors based on similarity in interest and expertise. However, please feel free to identify any faculty member(s) you may be interested in working with on the mentored research project (not required)
Below please include a 300-word description of your HIV research training, scholarship (i.e. publications, presentations, funding), and immediate and long-term research and career goals.  If applicable, please indicate any drug use research populations with which you have experience

Below please include a 150-word statement describing your interest and relevant training or experience in HIV prevention research ethics.

Below please include a 150-word description of the topic in HIV prevention research ethics that you would like to explore in the mentored research project (for examples of empirical research ethics articles, please view the selected bibliography on www.hivpreventionresearchethics.org)
Please describe the access you will have over the next 2 years to the HIV or HIV risk population you identified in your mentored research question. In your response please consider the sample size and geographic access that will be necessary to complete the project as described.
Please describe your relevant training and experience in the type of qualitative and/or quantitative methods proposed for this study.    This answer should also demonstrate your ability to independently design and implement a research project at standards suitable for peer review journals and potential NIH funding.


PLEASE ATTACH MOST RECENT C.V. Attachments must be in .DOC, .DOCX or .PDF format.
* UPLOAD :

 



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