FINAL APPLICATION DEADLINE: December 31
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
applicant:
1)
2)
3)
Please attach a STATEMENT OF GOALS for the training program (1-3 pages), a
curriculum vitae, and a copy of graduate transcripts. Unofficial copy is
acceptable, or transcripts may be sent separately to:
Linda Greco-Sanders
Department of Psychiatry
UCD Box F546
13001 E. 17th Place
Aurora, CO 80045
Applications and letters of reference should be emailed to Linda.GrecoSanders@ucdenver.edu.
Please complete the Equal Opportunity form on the next page.
Equal Opportunity and Affirmative Action Program
CITIZENSHIP
___ United States of America
___ Green card
ETHNICITY
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
RACE
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
strategies.)
□ 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
Islands.)
□ 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
information.
DISADVANTAGED BACKGROUND
As a child, did you or your family ever qualify for State or Federal assistance,
such as food stamps, free or reduced lunch, or other forms of monetary support?
□ Yes
□ No
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(s)
and whether it was pre-doc or post-doc:
________________________________________________________________
________________________________________________________________
________________________________________________________________
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