Diversity Fellowship Application

First Name *

Last Name *

Institution *

Department *

Are you a current member of ASNR? *

Email *

Number of years you have attended the ASNR Annual Meeting *

Age *

Which underrepresented ethnic or disability group do you most closely identify with? *

Highest Degree *

Date Degree Received *

Undergraduates and Graduate students who are enrolled in a degree seeking program are eligible for the fellowship. Awardees will be selected according to their academic background, experience, and research interests.

Current Academic Institution

Advisor Name

Advisor Email

Degree Being Sought

Are you a Postdoc, resident, or student? *

Yes

Clear Selection

Brief statement of research interests *
(Maximum characters: 2000)
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The following documents are required for your application and must be uploaded as a single PDF file:

Proof of documented disability
Current CV
Two letters of recommendation

Please upload your documents as a single PDF file here *

How did you learn of this Fellowship?
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If granted this award, I am willing to serve as a mentor to a first year Diversity Fellow during the third year of my Diversity Fellowship award. *

Yes

Clear Selection

If granted this award, I will plan to attend the next 3-years of ASNR Annual Meetings.

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