2012 Summer Fellowship in Translational Research & Bioethics International Institute of Bioethics & Patient Care Advancement

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1 2012 Summer Fellowship in Translational Research & Bioethics Dominique Monlezun, Admissions Committee Coordinator #420 Deming Pavillion~204 S. Saratoga St~ New Orleans, LA GENERAL INFORMATION The purpose of the Fellowship is to train the next generation of medical professionals, researchers, and health system leaders through clinical and/or basic lab research, an Externship Mentorship program, and Distinguished Lecturer Series in rediscovery of the patient-physician relationship, for the service of every patient. Medical and premedical students are encouraged to apply for one of two tracks: (1) Summer Fellowship as a rising 2nd year medical student or (2) Early Medical Scholars Program as a current junior or senior premedical student. Selected Fellows will participate in a week-long Distinguished Lecturer Series in Washington, D.C. from June 10th to June 15th, 2012 presented by top medical professionals, researchers, and legal experts. Transportation and lodging costs for the weeklong course will be provided along with an externship stipend. Following a 5-week externship, Fellows will gather again for the Fellowship Research Summit in Washington, D.C. on July 20th to present a poster on their clinical or basic lab research created during their externship under their respective mentor. On July 21st, Fellows will have the option of attending a bio-ethics training with Scott Klusendorf, M.A., President of Life Training Institute. NOTE: PRIOR RESEARCH IS NOT REQUIRED. QUALIFICATIONS OF APPLICANTS Students who have already participated in this program are not eligible. Previous applicants are eligible. Applicants must be enrolled in a 4-year university or medical school in the U.S. and in good standing at the time of the application. Applicants with any medical degree are not eligible. STUDENT RESPONSIBILITIES To begin the application process, students should send their CV directly to the Admissions Committee Coordinator no later than March 29, At that time, they must indicate a date they available for a 15 minute interview the Coordinator prior to April 9, Candidates will then receive a list of available mentors. Candidates must then complete and send the Admissions Coordinator their complete Application Packet, which will include their Application Form (see below) including their top 3 Externship Mentor Placement Preferences and a budget of proposed costs for the 5-week externship to be paid for in-part or fully by the Institute by April 2, Qualified Fellowships or Rotations will include those which: (1) are with a board-certified medical professional or researcher with appropriate credentials in good standing, (2) are with mentors accepted as Externship Mentors by the Institute (a list of qualified mentors will be provided upon request following submission of a student s CV), (3) can be completed within 5 weeks, (4) allow Fellows to produce and present a research poster at the July 20, 2012 Fellowship Research Summit. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ IMPORTANT DATES ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ April 2, 2012 Receipt Deadline for Complete Application (CV, Application Form, Externship Mentor Preferred Placements, and Budget) to be RECEIVED. April 13, 2012 Acceptance notices will be ed.

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3 Summer Fellowship in Translational Research & Bioethics Dominique Monlezun, Admissions Committee Coordinator #420 Deming Pavillion~204 S. Saratoga St~ New Orleans, LA TO: FROM: SUBJECT: Student Applicant Coordinator, Fellowship Admissions Committee Summer 2012 Fellowship Enclosed you will find the application packet for the 2012 Student Fellowship. Please read the following carefully. The application packet consists of: 1. Program Information Sheet 2. Student Responsibility Sheet 3. Application Form 4. Externship Placement Preferences 5. Proposed Budget No application packet will be evaluated if incomplete or not RECEIVED by April 2, 2012 Thank you for your cooperation.

4 =============================================================== Summer 2012 Fellowship in Translational Research & Bioethics Student Participant Responsibilities and Policies =============================================================== Award Payments Stipends are provided in two installments. The first payment will be issued at the end of the Distinguished Lecturer Series on June 15, The last payment will be issued after the Fellowship Research Summit on July 20, Change of Address Notification Advise the Admissions Committee Coordinator immediately of any pending address change. This will allow your prompt receipt of payments and aides our future communications with Fellowship Scholars. Living Quarters and Transportation Arrangements Housing will be provided for scholars during the Distinguished Lecturer Series and Research Summit in Washington, D.C. STUDENTS are responsible for arranging and supporting their own living quarters and travel for the Externship period. Depending on the Externship Placement, students should specify on the Application Form whether or not they will need housing through Institute contacts that may be available in the Placement region. Work Hours and Days Student participants are expected to commit full time (at least 40 hours a week for a 5-week period) to the Externship. The student and supervisor will determine the actual number of hours and days spent in the facility. Students might be expected to work some evenings or weekends as well. If you intend to complete courses during the Externship period, you may enroll in up to three units of course work in related fields following approval with your mentor. If you cannot work 40 hours per week, please indicate this to the Admissions Committee Coordinator at the time of application. Externship Placements The Admissions Committee will make every attempt to place Scholars in their top preference for the Externship Placement. Concluding Requirements Scholars must submit the following items at the end of the Externship period. Final payment will not be issued until the Admissions Committee receives the following: A two-page summary of your research and Externship experience Program evaluation questionnaire (provided at the Externship s completion) A completed Termination Notice form (instructions will be provided) Verification document of successful completion of an acceptable ethics course relating to training in the responsible conduct of research prior to the completion of the Externship. An example of an acceptable course can be found at

5 2012 Summer Fellowship Page 1 of 3 Summer Fellowship in Translational Research & Bioethics Dominique Monlezun, Admissions Committee Coordinator #420 Deming Pavillion~204 S. Saratoga St~ New Orleans, LA Summer Fellowship Application Form Application Packets Must be Complete and Received by April 2, 2012 SAVE THIS FILE TO YOUR COMPUTER BEFORE STARTING Attach this file to an upon completion and send to Last Name First Name Middle Initial Address (while attending school) City, State, Country, Zip Permanent Address (Parents) City, State, Country, Zip Telephone (cell) Address Date of Birth (month/day/year) Place of Birth City/State/Country Citizenship: (check one) U.S. Citizen or U.S. Noncitizen National Permanent Resident of U.S. Other Colleges or Universities Attended: (start with most recent) Date of Name of School, City, State Degree Degree Major Minor Medical Schools Attended: (start with most recent) Name of School, City, State Start Date Expected Completion

6 2012 Summer Fellowship Page 2 of 3 1. Describe the role of the patient-physician relationship and vulnerable patient populations in your own proposed career. 2. List honors, hobbies, special interests, or previous work experience that you would like the Committee to consider. 3. Have you done research or independent study previously? YES NO If yes, please describe (including possible publications): 4. Describe your motivation for applying to this program? How will it help you? (Include how you first became aware of this Fellowship and Externship).

7 2012 Summer Fellowship Page 3 of 3 5. List in ORDER OF PREFERENCE three Externship Placements in which you wish to participate. Choice Externship Mentor/ Researcher City / State 1 st 2 nd 3 rd 6. Detail your proposed budget (include transportation, housing, and other miscellaneous expenses). Specify if you are seeking housing with Fellowship contacts in your proposed Externship Placement region.

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