Brigham and Women’s Center for Surgery and Public Health A Joint Initiative of Harvard Medical School and Harvard School of Public Health Arthur Tracy Cabot Fellowship Application Cover Sheet The Center for Surgery and Public Health (CSPH)’s Arthur Tracy Cabot Fellowship supports qualified young scientists who wish to receive training in the research areas of surgical health services and implementation, education, and global health/surgery. In addition to being mentored by BWH surgeons, fellows have the opportunity to pursue a Master’s degree in Public Health at the Harvard School of Public Health. *All applicants must have either a MD or PhD. Preference will be given to candidates who are surgical residents or have completed a doctoral program in biostatistics. APPLICANT INFORMATION Last Name: First Name: Middle Name: Address: City: State: Phone Number: US Citizen: Zip Code: Email: Yes No Date of Birth: If no, please provide citizenship information: MEDICAL SCHOOL & RESIDENCY PROGRAM INFORMATION Current Residency Program: PGY Level: Year of Graduation: Medical School Attended: Year of Graduation: CABOT FELLOWSHIP INFORMATION Research Interest: Health Services / Outcomes / Comparative Effectiveness Research Education Research End-of-Life Research Implementation Science Global Health/Surgery Identified CSPH Faculty Mentor: OPTIONAL INFORMATION The CSPH has contracts with the Federal Government and is subject to federal reporting requirements. It would be helpful to us if you would provide the following information. Please check all that apply. Race: Ethnicity: Sex: American Indian or Alaska Native Hispanic or Latino Male Asian Not Hispanic or Latino Female Black or African American Native Hawaiian or Other Pacific Islander Disabled: White Yes Other No PROPOSAL Please prepare a research project proposal, using the Proposal Template provided online (maximum of 4 pages), to include the following: Personal statement outlining short- and long-term career goals (approximately 1 page) Proposed research project (approximately 2 pages) Educational plan including mentorship and educational activities (approximately 1 page) The Center for Surgery and Public Health is an Equal Opportunity / Affirmative Action Employer Page 1 Arthur Tracy Cabot Fellowship Application How did you hear about the CSPH Arthur Tracy Cabot Fellowship program? BWH Faculty Member Current Fellow Non-BWH Faculty Member Past Fellow CSPH Website Other: ___________________________________________________________________________________________ _____________________________________________________________________________________________________ Please be sure to include in your application packet: Please send all application materials to: Current CV Proposal (see instructions on previous page; download Proposal template from website) Official Medical School Transcript Two Letters of Recommendation (one from Residency Director or Chairman) *All letters of recommendation should be sent directly to the CSPH from the person providing the recommendation. Two Additional References Letter of Commitment from identified CSPH Faculty mentor (should detail your project plan and anticipate the use of funds if the fellowship is awarded) Jessica Appelson Project Manager, CSPH jappelson@partners.org If mail submission is necessary, please contact us in advance for application submission address. All application materials are due by Midnight on November 9th, 2015 Please contact CSPH’s Project Manager, Jessica Appelson, at jappelson@partners.org with any questions regarding the application process. The Center for Surgery and Public Health The Center for Surgery and Public Health (CSPH) was established in 2005 in collaboration with Harvard Medical School (HMS) and Harvard School of Public Health (HSPH) to improve surgical quality, safety, and access at the population level. Our research contributions to the fields of health services and implementation, education, and global health position the CSPH to reach beyond surgery to effect fundamental changes in the delivery of healthcare in the US and abroad. Distinguished by our team of surgeons and collaborators, the CSPH is committed to providing the next generation of surgeons with the skills and mentorship that will position them as leaders in the field of health services research. For more information on the CSPH and the Arthur Tracy Cabot Fellowship, please visit our website: http://www.brighamandwomens.org/Research/labs/CenterforSurgeryandPublicHealth/csph_fellowship.aspx Brigham and Women's Hospital Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery, and our leadership in patient quality and safety, development of state-of-the-art treatments and technologies, and robust research programs have improved the health of people around the world. Page 2