Indian Institute of Technology, Gandhinagar

Indian Institute of Technology, Gandhinagar

Summer 2018University at Albany School of Public Health/ Center for Global Health International Internship

APPLICATION FORM

BackgroundInformation

Summer 12-week International Internship working with the Indian Institute of Technology, Gandhinagar (IITGN) that offers an array of experiences including:

• Experience how public health research is conducted and/or public health practice occurs in India
• Fieldwork associated with collection of primary data (if planned well in advance, it may be possible to arrange for primary survey data to be collected on the pre-identified research topic the intern will work on)
• Conduct secondary data analysis of Indian data under the guidance of the internship mentor/s
• Work with (and learn) SAS, STATA and multilevel modeling

Internship projects will be developed based on a match with the interests of IITGN faculty who work on social determinants of undernutrition and obesity, socioeconomic patterning in health, access to safe water and sanitation, health of the elderly, modeling of vector-borne diseases and public health systems. Students with other research interests are strongly encouraged to apply as well. Please visit the following IITGN faculty profile website to get a better understanding of varied faculty interests:

Support offered by IITGN for the chosen intern candidate will include:

• Free shared housing in the dorms may be available (other privately paid housing may alsobe arranged)
• Stipend of 12,000 Indian Rupees (~U.S. $190) per month

Selection process will involve the submittal of the IITGN International Internship Application form with the finalists being interviewed by the Center for Global Health and by representatives from IITGN via distance. Selection of the intern candidate will be based on clear internship goals and good match with faculty interests.

Application Due Date: Completed Applications must be submitted by email to John Justino () by close of business on Wednesday, January 31, 2018.

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A. Student Information

Name of Applicant (Last, first, middle initial): / Address:
Email Address: / Phone Numbers:
MPH Concentration: / Name and Email of Faculty Advisor:

Undergraduate Education

Institution and location:

/

Degree Confirmed/Date

/

Field of Study

/

Cumulative GPA

Previous Experience Abroad

Country

/

Inclusive Dates

/

Purpose (5 - 10 words)

Foreign Languages Spoken:

/

Degree of Competency: Speaking Writing

B. Student Interests and Motivations

Research/Community Activity in College/Graduate School (use bullet points)

Research
Community Activity

Present Career Interests (200 – 300 words)

Courses taken previous which are/may be relevant to selected research topic

Briefly describe why your experience, qualifications and personal characteristics make you particularly suited for your role in this project? (300-400 words)

C.Resume / CV

Please attach an updated copy of their Resume or CV to your application.

D. References

Please submit a list of three academic and/or professional references, including their current titles and contact information.

E. Faculty Advisor Support

Applicants are also required to discuss their interest in the IITGN Summer internship with their Faculty Advisor and to then have their Advisor sign below as an indication of their support.

Name and Title of Faculty Advisor (please print)

Faculty Advisor SignatureDate

F. Release and Indemnification

I hereby elect voluntarily and on my own initiative to travel and work as an Indian Institute of Technology, Gandhinagar (IITGN) Summer Intern. I acknowledge that the full responsibility for any personal injury or illness, accident, risk or loss, or property damage that may be sustained by me as a result of being engaged in activities while I am an IITGN Intern is mine. In particular, I acknowledge that I am fully aware of the risks and hazards associated with my travel and international internship assignment at IITGN, including risks relating to political unrest in connection with my travel to certain countries.

I acknowledge that the IITGN Internship Committee and theUniversity at Albany School of Public Health shall not be responsible for any illness, injury, accident, damage or loss suffered by me from or in connection with my participation as an IITGN Intern, and hereby release and agree to hold harmless the IITGN Internship Committee and the University at Albany School of Public Health, and its officers, directors, employees, and agents from any liability, illness, injury, or accident that may be sustained by me while participating as an IITGN Intern.

I further acknowledge that I have adequate health and accident insurance.

This release and hold harmless agreement is binding on myself, heirs, assigns, and personal representatives.

Name of Applicant (please print)

Applicant SignatureDate

G. Certification

APPLICANT CERTIFICANTION AND ACCEPTANCE: I hereby certify that the statements herein and the information in the attached documents are true and accurate to the best of my knowledge.

Name of Applicant (please print)

Applicant SignatureDate

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Indian Institute of Technology, Gandhinagar – Summer 2018 International Internship Application