Stanford-NBC News Fellowship in Media and Global Health

Application for 2015-2016 Academic Year

Instructions

Please type in the shaded areas. All documents must be received (via e-mail or post) by 3 pm PST, Tuesday, February 17, 2015. This fellowship begins in June 2015.

You will need the following:

·  this completed application;

·  letter of interest which includes your career goals within the field of global health and how this fellowship will be helpful to you;

·  two letters of recommendation preferably from supervisors of global health activities;

·  current CV.

Please email or mail all application materials in one packet (with exception of letters of recommendation which should be emailed separately) to:

Andrea Sprockett, Director of Educational Programs in Global Health

Stanford University

Stanford University Center for Innovation in Global Health

1265 Welch Road, X3C42

Stanford, CA 94305

Email Address:

Personal Information

Name

Address

City, State, Zip

Home Telephone

Country of Citizenship

Email Address

Background/Experience

Institution:

Affiliation: Medical Student Resident Faculty

Current Year: Med Student Year 2 Med Student Year 3 Med Student Year 4

Intern PGY-2 PGY-3 PGY-4 Other:

If you are a resident, please specify specialty: Medicine Pediatrics Surgery Ophthalmology

OB/GYN Emergency Medicine Other

Languages:

Spoken Proficiency Level*:

Elementary proficiency Limited working proficiency Minimum professional proficiency

Full professional proficiency Native or bilingual proficiency

Reading Level*:

Elementary proficiency Limited working proficiency Minimum professional proficiency

Full professional proficiency Native or bilingual proficiency

Writing Level*:

Elementary proficiency Limited working proficiency Minimum professional proficiency

Full professional proficiency Native or bilingual proficiency

*Learn more about language proficiency levels here.

Have you had prior experience working in health care settings outside of the US? Yes No

If yes, provide locations, dates, sponsoring organization, and describe briefly your experience?

What do you hope to gain through this fellowship and where you see yourself in five years?

Of types of media listed below, please rank which is most interesting to you from 1 to 5.

(1 is most interested and 5 is least interested)

Photography

Print

Radio

Social Networking

Television

skills rating

How would you rate yourself in the following areas from 1 – 10 (1 is a beginner and 10 is advanced):

1.  Word Processing

2.  Spreadsheets

3.  Web Publishing

4.  Email

5.  Presentation

6.  Database

7.  Photo Editing

Year-Long Project

As part of this fellowship, fellow will be mentored toward the goal of producing a publication in a global health topic of choice. List three topics that you might want to investigate in-depth during the fellowship and your reasons for choosing these topics.

1.

2.

3.

Deadline to apply

February 5, 2014