FINAL APPLICATION DEADLINE - University of Colorado Denver

Postdoctoral Research Training Program
in Developmental Psychobiology
Name _________________________________________________________
Best address ___________________________________________________
Phone Day (
) ________________
Evening (
) __________________
E-mail address ____________________________
Degree __________________ Month/Year of Degree __________/_______
Institution of Degree _______________________________________________
Earliest possible start date in the program _________ / _________ / ________
Major area of interest (summarized) __________________________________
Applicants should indicate which faculty member(s) they wish to have serve as
their sponsor(s), and in whose laboratory they will primarily work. Prior to
applying, you must contact the faculty member to ensure that he/she will be
available to sponsor you; phone numbers are listed on each faculty sub-page.
Primary sponsor _________________________________________________
Co-sponsor, if applicable __________________________________________
Names of three persons who will submit letters of recommendation for the
Please attach a STATEMENT OF GOALS for the training program (1-3 pages), a
curriculum vitae, and a copy of graduate transcripts (unofficial copy acceptable,
or transcripts may be sent separately). Sent to:
Randy Ross, M.D.
Department of Psychiatry
University of Colorado at Denver and Health Sciences Center
4200 East 9th Avenue, Box C268-58
Denver, CO 80262
Applications and letters of reference may be emailed to Linda Greco-Sanders at
Please complete the Equal Opportunity form on the next page.
Equal Opportunity and Affirmative Action Program
1. Do you consider yourself to be Hispanic or Latino? (A person of Mexican,
Puerto Rican, Cuban, South or Central American, or other Spanish culture of
origin, regardless of race. The term, “Spanish origin,” can be used in addition
to “Hispanic or Latino.”)
□ Hispanic or Latino
□ Not Hispanic or Latino
2. What race do you consider yourself to be? Select one or more of the following.
□ American Indian or Alaska Native. (A person having origins in any of the
original peoples of North, Central, or South America, and who maintains
tribal affiliation or community attachment.)
□ Asian. (A person having origins in any of the original peoples of the Far
East, Southeast Asia, or the Indian subcontinent, including, for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam. Note: Individuals from the Philippine
Islands have been recorded as Pacific Islanders in previous data collection
□ Black or African American. (A person having origins in any of the black
racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in
addition to “Black” or African American.”)
□ Native Hawaiian or Other Pacific Islander. (A person having origins in
any of the original peoples of Hawaii, Guam, Samoa, or other Pacific
□ White. (A person having origins in any of the original peoples of Europe,
the Middle East, or North Africa.)
□ Check here if you do not wish to provide some or all of the above
Do you come from a family with an annual income below established low-income
thresholds?*  Yes
 No
* thresholds are based on family size, published by the U.S. Bureau of the
Census, adjusted annually for changes in the Consumer Price Index, and
adjusted by the Secretary for use in all health professions programs. The
Secretary periodically publishes these income levels at Individuals from low-income
backgrounds must be able to demonstrate that they have (a) qualified for Federal
disadvantaged assistance, or (b) have received any of the following student
loans: Health Professional Student Loans (HPSL), Loans for Disadvantaged
Student Program, or (c) have received scholarships from the U.S. Department of
Health and Human Services under the Scholarship for Individuals with
Exceptional Financial Need.
Are you:
□ Disabled Veteran
□ Handicapped
Do you have a physical or mental impairment which substantially limits one or
more major life activities?
□ Yes
□ No
Will you need special accommodations?
□ Yes
□ No
If so, please explain ________________________________________________
How did you hear of this position? _____________________________________
Have you ever had NRSA funding in the past? If so, please list grant number and
whether it was pre-doc or post-doc: