NYU-HHC Clinical and Translational Science Institute Postdoctoral Primary Care Research Fellowship Eligibility: Upon entrance to the program, an applicant must be: Board Eligible or Certified in Pediatrics or Internal Medicine Planning a career involving primary care research Currently licensed to practice medicine in New York State Application Process: Deadline: Rolling, until positions are filled Please send the following materials electronically to Leyda.Taveras@nyumc.org: 1. The application form (attached). 2. Current curriculum vitae; proof of medical licensure (if applicable) 3. Complete an essay of no more than 1000 words describing: o Your reasons for seeking advanced training in Primary Care Research o A potential research project that you would be interested in pursuing o Your career plans beyond this Fellowship 4. Have your three letters of recommendation sent to Leyda.Taveras@nyumc.org: o Two letters from faculty, which should address the applicant’s potential to become an independent investigator One letter from your current Department Chair, Program Director or Division Director *We particularly encourage applications disadvantaged, and the disabled. from women, underrepresented minorities, When all materials listed above have been received, we will contact you regarding the availability of interview with program faculty. For more information about the application process or general inquiries contact: Leyda Taveras Program Manager, Fellowship in Primary Care Research Department of Pediatrics NYU School of Medicine Bellevue Hospital Center 462 First Avenue, Room A320 New York, NY 10016 212-562-3154 Leyda.taveras@nyumc.org the NYU-HHC Clinical and Translational Science Institute Postdoctoral Primary Care Research Fellowship Application Form Date: Applying for Program Beginning: Personal Information Full Name: Gender: Male Female Birth Date: Citizenship: Institution Information US Citizen Permanent Resident Visa: ________ Current Institution: Current Position: Department: Division (if applicable): Contact Information Home Address: Work Address: Home Phone #: Preferred Email: Work Phone #: Demographic Information Work Email: 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 Are you from a disadvantaged background? Yes Other: Do not wish to provide No Do not wish to provide NYU-HHC Clinical and Translational Science Institute Education Information Degree: Date Granted: Institution: Degree: Date Granted: Institution: Degree: Date Granted: Institution: Degree: Date Granted: Institution: Training Information (if applicable) Institution: Position Held: Dates Institution: Position Held: Dates Institution: Position Held: Dates Research Experience (if applicable) Institution: Position Held: Dates Institution: Position Held: Dates Institution: Position Held: Dates Clinical Experience (if applicable) Specialty: Board: Eligible Certified Dates Eligible Certified Dates Sub-Specialty: Board: How did you hear about our program?: