JUNIOR FACULTY SUPPORT OPPORTUNITIES:
2016-2018 FACULTY FELLOWSHIP TO BE AWARDED
SUBMISSION DEADLINE WEDNESDAY, OCTOBER 14, 2015: EXTENDED TO WEDNESDAY, OCTOBER 21, 2015
Office for Diversity Inclusion and Community Partnership (DICP) Faculty Fellowship
A two-year, non-degree Faculty Fellowship Program for Harvard Medical School (HMS) junior faculty that enables fellows to pursue activities that enhance
their career development as researchers and clinicians/teachers, leads to their advancement within the Harvard system, and promotes diversity within the
HMS community. The Program will provide two years of fellowship support in the amount of $50,000 per year intended to provide release time from
clinical work to conduct an individual, mentored research project. Fellows will also participate in Fellowship-related activities, meet regularly with mentors,
and present research findings at the Minority Health Policy Annual Meeting.
DICP Faculty Fellowship Eligibility
 Doctoral degree (e.g. MD, PhD, DO, DMD, DDS, ScD). Harvard Medical School appointment at the level of instructor or assistant professor.
Applications will also be considered from clinical or research fellows who are in the process of appointment/promotion to instructor and/or
assistant professor at HMS.
Harvard Catalyst Program for Faculty Development and Diversity Inclusion (PFDD) Faculty Fellowship
Harvard Catalyst Program for Faculty Development and Diversity Inclusion (PFDD) Faculty Fellowship is a two-year, non-degree Faculty Fellowship Program
for Harvard junior faculty designed to address faculty need for additional support to conduct clinical/translational research and to free junior faculty from
clinical and teaching demands at a key point in their career development. Each Faculty Fellow will receive $100,000 over a two-year period to support their
scholarly efforts. Faculty Fellows are required to devote appropriate time toward the development of their academic career, to meet regularly with their
mentors, and to present at the annual Minority Health Policy Meeting. For more information about Harvard Catalyst see: http://catalyst.harvard.edu/
Harvard Catalyst PFDD Faculty Fellowship Eligibility
 Doctoral degree (e.g. MD, PhD, DO, DMD, DDS, ScD). Harvard appointment at the level of instructor or assistant professor. Applications will also
be considered from clinical or research fellows who are in the process of appointment/promotion to instructor and/or assistant professor at
Harvard.
 U.S. Citizenship or Permanent Residency
 If you currently receive funding from a federal training and/or career development grant (T or K awards), please contact the fellowship Program
Coordinator before submitting your Faculty Fellowship application.
Application Packet Must Include:

Completed application

Personal statement (600 words maximum)

Statement of research/fellowship-funded proposed activity (5 pages maximum), bibliography and list of current and pending funding

Abstract

Two letters of recommendation from:

Department Chair or Division Chief. This letter must include:

Commitment to continue to support this individual in their career development over time

Potential role this individual will play in the department/division over time

Statement explaining how the funds ($50K per year) will alter the Faculty Fellow’s activities, impact/relate to
his/her career goals and indicate the percentage of time that will be protected as a result of this Faculty Fellowship

Agreement to meet with this individual bi-annually for career planning meetings

Mentor. This letter must include:

Description of the project

Commitment to mentor and support the Faculty Fellow for a minimum of the two-year fellowship period
 Curriculum Vitae according to Harvard Medical School format. An example may be found at
http://www2.massgeneral.org/MoskowitzLab/SMMoskowitz_HMS_CV_2009_web.pdf
Submission and Contact Information:
 Download application at: https://mfdp.med.harvard.edu/dcp-programs/faculty. Completed application and all accompanying materials must be
received no later than Wednesday, October 14, 2015 the extended deadline of Wednesday, October21, 2015. Applicants will be notified of final
decisions by late-February 2016.
 Mail packet or hand deliver to: HMS Faculty Fellowship Programs, Office for Diversity Inclusion and Community Partnership,
164 Longwood Avenue – 2nd Floor, Boston, MA 02115
 Contact for additional information: Terésa Carter, DCP Program Coordinator, teresa_carter@hms.harvard.edu, 617-432-4697
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2016-2018 DICP and Harvard Catalyst Program for Faculty Development and Diversity Inclusion (PFDD) Faculty Fellowship Application
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2016-2018 DICP and Harvard Catalyst PFDD Faculty Fellowship Application
APPLICATION TO BOTH FELLOWSHIPS PERMISSIBLE – ALTHOUGH APPLICANTS CAN RECEIVE ONLY ONE AWARD
(PLEASE CHECK ALL THAT APPLY):
Office for Diversity Inclusion and Community Partnership (DICP) Faculty Fellowship
Harvard Catalyst Program for Faculty Development and Diversity Inclusion (PFDD) Faculty Fellowship
PERSONAL INFORMATION:
Name:
Last
First
Middle
Degree(s):
Academic Title:
Institutional Title (Clinical/Research/Administrative):
Institution:
Department/Division:
Specialty:
Office Address:
Office Telephone:
Office Fax:
Email:
Cell Phone:
U.S. Citizen:
Yes
No
Permanent Resident:
Yes
No Other: Specify ______________
SEX RACE/ETHNICITY INFORMATION:
Please check appropriate boxes. (Optional)
Sex:
M
F
Race/Ethnicity (for multiple races, specify in respective categories below):
1. Do you consider yourself to be Hispanic/Latino?
No
Yes
1.a. If yes, please check all that apply:
Cuban
Dominican
Mexican, Mexican American, Chicano
Puerto Rican
South or Central American
Other (specify):
___________________________________________________________________________________________
2016-2018 DICP and Harvard Catalyst Program for Faculty Development and Diversity Inclusion (PFDD) Faculty Fellowship Application
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Name (Please print)
2. How do you identify your race? Please check all that apply.
American Indian or Alaska Native
2.a. If yes, please specify name of enrolled or principal
tribe:
Asian
2.b. If yes, please check all that apply:
Asian Indian
Cambodian
Chinese
Filipino
Japanese
Korean
Pakistani
Vietnamese
Other (specify):
Black or African American
2.c. If yes, please check all that apply:
African American
Caribbean or West Indian
African (specify country)
Other (specify)
Native Hawaiian or other Pacific Islander
2.d. If yes, please check all that apply:
Guamanian or Chamorro
Native Hawaiian
Samoan
Other Pacific Islander (specify)
White
Other (specify)
Letters of Recommendation from Department Head/Division Chief and Mentor
Please include one letter of recommendation from your Department Chair/Division Chief and one letter of recommendation from your
mentor.
Name of Department Chair or Division Chief:
Office Telephone:
Office Fax:
Name of Mentor:
Mentor Title:
Office Telephone:
Office Fax:
Email:
Email:
Current Percent Distribution of HMS-related Effort (Please provide current percentages for all that apply – total should be 100%):
Teaching
%
Community Service
Clinical
%
other
%
Research
%
Administrative
%
Administrative
%
% (please provide description)
Proposed Percent Re-Distribution of Effort Based on Funding:
Teaching
%
Community Service
Clinical
%
other
%
Research
%
% (please provide description)
___________________________________________________________________________________________
2016-2018 DICP and Harvard Catalyst Program for Faculty Development and Diversity Inclusion (PFDD) Faculty Fellowship Application
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Personal Statement – (Attachment, 600 words maximum)
Please write a personal statement that includes the following: A) your career objectives; B) a description of current career obstacles you
may face; C) how the Fellowship’s financial support will allow you to modify your present activities; and D) how you see the Fellowship
contributing to the achievement of your professional objectives. The statement should not exceed six hundred words. Please write your
statement on a separate sheet and attach it to this application.
Statement of Research & Bibliography – (Attachment, 5 pages excluding bibliography)
Please write a statement of research that includes a summary of the research project proposal, plus bibliography. Proposal should be
single-spaced, 12-point Times New Roman font, with 1” margins and must include the following: A) specific aims; B) background and
significance; C) preliminary studies, if applicable; D) research designs and methods, including expected outcome; E) human subject
research, if applicable; F) timeline; and G) bibliography. Note: Applications for the Harvard Catalyst PFDD Faculty Fellowship should focus
on clinical and translational research. The statement should not exceed five pages. The bibliography is not included within those 5 pages.
Please write your statement on a separate sheet and attach it to this application.
Abstract – (Attachment, 250 words)
IRB Requirements
Does your study require IRB or IACUC approval?
If yes, do you already have approval?
Yes
Yes
No
No* (If yes, please attach proof of approval when submitting application.)
*If your project requires IRB or IACUC approval but you do not have it at this time, you will need to have submitted your
protocol(s) to the relevant board(s) no later than December 4, 2015. Proof of submission should be sent to the fellowship
Program Coordinator. If accepted for a fellowship, proof of approval must be submitted to the Program Coordinator before
the fellowship start date in order to maintain eligibility.
How did you learn about the DICP and Harvard Catalyst Diversity Inclusion Faculty Fellowship Programs?
Please check all boxes that apply.
Received mailing
Department Chair/Division Chief
Harvard faculty member
Website: (please describe)
Harvard staff member
Email
Other: (please describe)
Special Note:
 Faculty Fellowship funding is not transferable to non-Harvard or non-Harvard affiliated institutions.
 Transfer within HMS requires DCP review and written approval.
 You must follow your institution’s procedure for submitting your application to its internal research administration office and, if
applicable, to your institution’s human subjects review board.
I hereby certify that the information given by me in this application is complete and accurate and I understand that any
misrepresentation or omissions may be cause for denial or revocation of acceptance or subsequent dismissal from the Fellowship. I also
understand that my application and any materials submitted with my application become the property of the Harvard Medical School
Office for Diversity Inclusion and Community Partnership and cannot be returned to me, and that the review committee’s decision is final
and not subject to appeal.
Signature _____________________________________________________________ Date
Name (Please print)
Application, personal statement, statement of research, two letters of recommendation and curriculum vitae
must be submitted no later than Wednesday, October 14, 2015
the extended deadline of Wednesday, October 21, 2015.
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2016-2018 DICP and Harvard Catalyst Program for Faculty Development and Diversity Inclusion (PFDD) Faculty Fellowship Application
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