APPLICATION FOR THE 2013/14 CARTA PHD FELLOWSHIPS INSTRUCTIONS Please read all the instructions carefully and complete all sections. Note to applicant: This application form will be used for the institutional selection process. If you are successful at the institutional level, you are encouraged to submit a revised application for the final selection. 1. The application form should be submitted in Microsoft Word in Arial font, size 11, single-spaced. Applicants should save their file using the following format: lastname_firstname_carta2013.doc 2. Incomplete applications and all applications that do not meet formatting requirements (including page limits) will not be reviewed 3. All applicants should review the eligibility criteria specified in the call for applications as those not meeting these criteria will not be considered 4. In addition to this application form, a complete package should include a reference letter from one referee. Referees should email the reference letter directly to the focal person with a copy to carta@aphrc.org 5. Applicants must ensure that scanned copies of any documents are legible 6. For your application to be considered, it must reach CARTA’s focal person at your institution by April 15, 2013. Any application submitted later than this date will NOT be considered 7. Please submit your application electronically to the focal person(s) at your institution AND email a copy to carta@aphrc.org 2013/14-CARTA-APPLICATION 1 PERSONAL DETAILS Last Name: First and Middle Name: Address: Telephone number: Mobile number: Email address: Date of Birth: Gender: Nationality: Employer/Institution: Department: DETAILS OF PROPOSED DOCTORAL STUDIES Title of proposed project: Are you currently working on a research project in which your PhD can be nested? If yes, please provide the name of the research project Have you discussed your research with any senior colleague or potential supervisor? 2013/14-CARTA-APPLICATION 2 OUTLINE OF PROPOSED RESEARCH PROJECT The intention of this section is to assess your ability to write a coherent approach to research, we understand that your actual research project may be different from what is presented below 1. Research plan. This should include a statement of the problem, the research questions, and the proposed methods and data sources (maximum 2 pages) TYPE HERE 2. Significance. Provide a brief description of the scholarly contribution your proposed research will make, as well as its relevance to contemporary public and population health issues in Africa. (maximum 1 page) TYPE HERE 3. Motivation essay. Provide a brief narrative explaining why doing a PhD is important to you. Suggested issues to cover: long-term career goals; research interests and future research involvement; teaching interests and future teaching roles; previous efforts to obtain a PhD (maximum 2 pages) TYPE HERE 2013/14-CARTA-APPLICATION 3 APPLICANT’S CURRICULUM VITAE Degree Institution Dates attended (mm/yyyymm/yyyy) Position Institution Employment period (mm/yyyymm/yyyy) EDUCATION Include month and year of graduation (or expected date), major, faculty/department, thesis title (if any), and degrees or certification. Begin with the most recent degree EMPLOYMENT HISTORY List in chronological order (beginning with current or most recent employment), include position details, dates, and reason(s) for leaving previous jobs COMPUTER SKILLS List computer packages and level of skill (i.e. basic, intermediate, and advanced) PUBLICATIONS Provide full reference for ALL your publications CONFERENCE PRESENTATIONS PROFESSIONAL MEMBERSHIPS AWARDS, HONORS, AND GRANTS RECEIVED 2013/14-CARTA-APPLICATION 4 Please include the following document Letter of reference (provide your referee’s information below). Referees should email the letter of reference directly to the focal person with a copy to carta@aphrc.org Name Title Affiliation Address Telephone Email 2013/14-CARTA-APPLICATION 5