2016 DEPARTMENT OF POPULATION HEALTH
SUMMER RESEARCH FELLOWSHIP APPLICATION
DIRECTIONS
Application Instructions: Students who wish to apply for the fellowship should review the listing of all available
projects. Once the student has identified a project in which they are interested, the student should meet with
the faculty advisor and then submit a fellowship application (attached).
All applications should be emailed to Dr. Mark Schwartz at Mark.Schwartz@nyumc.org and
Kathryn.Nyland@nyumc.org as a PDF document by February 12, 2016. Applications must be signed by both
the student and mentor in order to be considered. Applications will be reviewed by the Department of
Population Health Fellowship Committee. All students who are admitted to the fellowship will be given a
stipend through the Department of Population Health. If a student is work study eligible, the Department of
Population Health will provide the additional funding required; if a student is NOT work study eligible the
Department will fully fund the students work for the summer.
We hope you find this opportunity as exciting as we do and look forward to working with you to arrange for an
educationally challenging and rewarding research experience. If you have any questions, please do not
hesitate to contact either one of us.
Submission Deadline: February 12, 2016.
Applicants will be notified of their status on or before March 14, 2016.
For questions about the application process, please contact:
Kathryn Nyland at Kathryn.Nyland@nyumc.org or (646) 501-2627
2016 DEPARTMENT OF POPULATION HEALTH
SUMMER RESEARCH FELLOWSHIP APPLICATION/MENTOR CONTRACT
Personal Information
Full Name:
Gender:
M
F
Birth Date:
Class of:
Email:
Phone:
Permanent Address:
School Address:
Project Information
Research Project Title:
Mentor’s Name:
Mentor’s Email:
Mentor’s Division:
Work Study Eligible?
Educational Background
Yes
No
Undergraduate Institution
and Location:
Months and Years Attended:
Major Field of Study:
Degree Received:
Demographic Information
Month and Year:
Do you consider yourself to
be:
Hispanic or Latino?
Do not wish to provide
What is your racial
background?
(Check all that apply)
American Indian/Alaska Native
Asian
Black or African American
Hawaiian/Pacific Islander
Other:
White
Do not wish to provide
Additional Information
Do you have a disability?
Yes
No
Do not wish to provide
If yes, which describes
your disability?
Hearing
Visual
Mobility/Orthopedic
Other: _____________________
Do not wish to provide
Are you from a
disadvantaged
background?
Yes
Do not wish to provide
No
Essay
Within the space allotted, briefly address the following three items:
 Describe your interest in learning about research.
 What led you to apply for this particular opportunity?
 Describe the research proposal and your role in it.
Signatures
Student’s Signature:
Mentor’s Signature:
Email this completed application to Mark.Schwartz@nyumc.org and Kathryn.Nyland@nyumc.org
Deadline: Friday February 12, 2016