Name and Contact Information
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* Example: (206) 222-2222
Example: (206) 222-2222
Mailing Address
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Citizenship
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  2. * Noncitizen nationals of the United States are persons born in American Samoa, certain former citizens of the former Trust Territory of the Pacific Islands, and certain children of noncitizen nationals born abroad.

Current Professional Position
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Do you have a pending application for any other PHS-mentored career development awards? *
  1. This includes any pending awards (e.g., K07, K08, K22, K23 or any program that duplicates any of the provisions of the KL2 program.) as of Dec. 15.

Personal Statement

Please provide the selection committee with a statement with the following sections. Please limit this whole statement to one page with 1 inch margins and size 12 font.

Include:

  1. your interest in this program;
  2. your background and clinical research experience;
  3. your long-term career plans; and
  4. how you will use the training program to advance your plans.

Maximum 5 megabyte size.

Curriculum Vitae

Please provide the selection committee with a current version of your curriculum vitae.

Maximum 5 megabyte size.

Statement of Plans

Please outline your plans in the event you receive this award. What didactic plans do you have? Please describe your research interests and potential research projects you would pursue, and specific mentors at the University of Washington you might work with, if you know them at this point. This statement should be no longer than 2 pages, with 1 inch margins and size 12 font.

Maximum 5 megabyte size.

References

Please list the individuals who will be submitting an evaluation form and letters of support on your behalf; 3 references are required. These should include letters from your current department chair or division chief, current residency program director (if applicable), and current research mentor (if applicable). Please note that reference letters should be sent directly to

  • Frederick P. Rivara, MD, MPH
  • Harborview Injury Prevention and Research Center
  • Box 359960
  • 325 Ninth Ave
  • Seattle WA 91804
  • email: fpr@uw.edu
  • fax: (206) 744-9962

Letters must be received by March 1, 2012.

Reference 1
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Reference 2
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Reference 3
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Non-discrimination/Disability Access Policy

University of Washington reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations. The University of Washington is committed to providing access, equal opportunity and reasonable accommodation in its services, programs, activities, education and employment for individuals with disabilities.

Optional Diversity Information

Consistent with our goal of enhancing the intellectual and social enrichment of the University community, the University of Washington actively seeks and welcomes applicants from diverse backgrounds. We are asked to maintain gender, ethnicity and disadvantage information for federal grants and other statistical purposes. Therefore, we would appreciate information about:

Gender


Race and Ethnicity
  1. Select all that apply.

Disability

Do you have a disability?



Persons with disabilities are persons with a permanent physical, mental, or sensory impairment which substantially limits one or more major life activity. Physical, mental, or sensory impairment means: (a) Any physiological or neurological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the body systems or functions; or (b) any mental or psychological disorders such as mental retardation, organic brain syndrome, emotional or mental illness, or any specific learning disability. The impairment must be material rather than slight, and permanent in that it is seldom fully corrected by medical replacement, therapy, or surgical means.

Disadvantaged Backgrounds

The University of Washington and the Department actively seek and welcome students from diverse backgrounds. If you wish to have factors such as varied cultural experiences, educational or socioeconomically disadvantaged background or disability included in the review of your application, write a brief statement not to exceed one single-spaced page. The statement should address the ways those experiences have affected the development of your special interests, career plans, future goals, and how you may have overcome various obstacles. This statement is Optional. If you have little to say, please omit it from your application.

Maximum 5 megabyte size upload.

Please be patient. Uploading large files may take a bit of time.