Proshek-Fulbright Fellowship
The J. William Fulbright Commission in the Czech Republic and the Proshek Foundation invite
applications for Proshek-Fulbright Fellowship for 2006/2007.
The Proshek Fellowship was established by the estate of Mrs. Gabriela Proshek to honor her late
husband, Dr. Charles E. Proshek, a distinguished physician in Minneapolis, Minnesota, and former
Honorary Consul of the Czechoslovak Republic. Mrs. Proshek, daughter of the well-known Czech
writer, Gabriela Preissová, shared with her husband a sense of responsibility for improving mutual
relations between that country and the United States.
Starting with 1998/99 academic years, an agreement between the Proshek Foundation and the J.
William Fulbright Commission was reached. The Fulbright Commission is to administer the ProshekFulbright Fellowships and cover the round-trip travel and health insurance for the grantees. The
grantees are to be selected by a selection committee consisting of the representatives of the Fulbright
Program and the Proshek Foundation.
The purpose of the Fellowship is to provide medical scholars an opportunity to participate in
observation, consultation, teaching and research. The University of Minnesota accepted the
responsibility to administer the fellowship in the USA. It seeks highly qualified members of the
medical profession who have interest in furthering medical science and cultural ties between the
Czech Republic and the United States. (The Fellowship does not provide for clinical training).
Each year, Fellowships supports up to three scholars for a visit of three to ten months. This award may
not be extended; recipient is expected to return to the home country at the conclusion of the
Fellowship (J1 visa status is connected with the home residency requirement).
The Fellowship includes a monthly stipend to cover living expenses in Minnesota, plus round- trip
transportation from the Czech Republic to Minneapolis, Minnesota, and appropriate health insurance.
The Fellowship does not cover dependents' costs.
Eligibility Requirements:
The Fellowship is open to individuals who meet the following criteria:
1. Are citizens of the Czech Republic at the time of the application and do not hold a green card.
2. Are involved in a medical or related basic science field, which is defined as:
- an accredited clinical medical field that traditionally produces medical practitioners,
- a related basic science generally associated with medical faculties in fields such as anatomy,
genetics, and other biological sciences, or
- one of the other health science fields such as nursing, public health, dentistry, and pharmacy.
3. Are currently engaged as one of the following in the Czech Republic:
- junior faculty members currently affiliated with medical school, universities, or centers,
- research scholars currently associated with medical research institutions,
- recent graduates of medical schools or universities seeking to undertake post doctoral research or
activity,
- established researcher scholars from medical schools or universities, or independent medical research
centers or academies, or
- faculty from established medical schools or universities.
4. Are competent in written and spoken English as documented by the TOEFL (Test of English as a
Foreign Language) or the TELP (Test of English Language Proficiency). The applicants take the TELP
on the day of the interview.
Instructions
1. Deadline
The Proshek-Fulbright Fellowship Committee regrets that it cannot consider applications that arrive in
the offices of the Fulbright Commission in the Czech Republic later than February 1 of a calendar
year. Only complete applications are considered.
2. Application
A complete application dossier should include:
- a completed Application Form,
- a detailed Statement of Proposed Activities,
- three Letters of Reference mailed directly to the Fulbright Commission of the Czech Republic by the
referees,
- evidence of facility in the English language as documented by the Test of English as a Foreign
Language (TOEFL) or the TELP (Test of English Language Proficiency). A score of 213 (computerbased score) or 550 (paper-based score) on the TOEFL is desired, although candidates scoring
somewhat lower may be selected.
Application Form:
Please feel free to add information not requested on the form if you feel that the questions do not
reflect your background, or if you feel that such information enhances your candidacy. Use up to one
additional sheet of paper if necessary.
Statement of Proposed Activities:
This statement is decisive in finding suitable placement for you at the University of Minnesota
Medical School. It should be a well-written and conceptualized two or three-page statement of what
you plan to accomplish, the methods you plan to use, and the relevance of this planned activity to your
career and to medical science in the Czech Republic. The planned activity must be feasible within the
period of time for which the grant is requested. It should identify resources and facilities needed to
achieve the objectives. (Applicants should visit the University of Minnesota Medical School's
homepage at http://www.med.umn.edu to gather information about the Medical School, its faculty,
departments, and programs.)
Letters of Reference:
References are very important for demonstrating specific areas of excellence in the field, future
promise, and relevance of the proposed activity to the development of medicine or medical sciences.
References should comment on the candidate's integrity and personal and professional attributes. The
references should be sent directly to the selection committee (Fulbright Commission, Táboritská 23,
130 87 Praha 3, fax: +420-222729868).
English Language Examination Results:
Forward the result slips with your other application materials in case you passed any English language
exam in the past. If not, you will sit for the TELP on the day of the interview.
Additional Information (optional):
Include additional evidence of distinguished accomplishments in studies, clinical and basic sciences,
professional achievement, research, or publications.
3. Additional Instructions
Please type or wordprocess your Application Form and Statement of Proposed Activity.
Please provide complete addresses for your home and office, as well as complete fax numbers, phone
numbers, and e-mail addresses (if available).
Detailed information concerning items 6 and 7 of the Application Form may be provided using
additional sheets of paper.
Specify information about any contacts you may have at the University of Minnesota or elsewhere in
the United States. It is strongly recommended to establish contacts with the University of Minnesota
School of Medicine prior to submitting the application and it is definitely to your advantage to have
proposed collaboration with current faculty members of the University of Minnesota Medical School
(see item 14 on the Application Form).
Proshek-Fulbright Fellowship
1. Name:
2. Current Academic or Professional Affiliation
Institution:
Department:
Position:
Title:
3. Address at Place of Employment:
Telephone Number:
E-mail Address:
Fax Number:
4. Home Address:
Telephone Number:
E-mail Address:
Fax Number:
5. Citizenship:
6. Education
University or Institute Field Dates Degree:
Highest Degree Earned:
Date Awarded:
Major Field of Study:
Specialization ___________________
7. Professional Positions Held (including residencies and internships)
University or Institution Field Dates Certification:
8. Personal Data
Date of Birth:
Sex:
Family Members Who Will Accompany You to Minnesota (Name and Date of Birth)
Spouse:
Children:
9. English Language Test Results
Name of Test:
Score:
Date/Location of Test:
10. Honors, Awards, Fellowships, Scholarships Received:
11. Publications:
A complete listing of all publications must be included in your curriculum vitae, which must be
translated into English. Use the standard format for bibliographic citation.
12. References
These colleagues should know your work, and at least one should be from outside your university.
Name
Title
Address
1.
2.
3.
13. Memberships in Professional and Scientific Associations:
14. Names and Departments of Collaborating Faculty at the University of Minnesota
Name
Department
15. Names and Addresses of Other U.S. University and Professional Contacts
Name
Address
16. Previous International Activities or Travel (attach a separate sheet if needed):
17. Dates for Which Fellowship Sought:
Date you expect to:
a) Depart your home country:
b) Begin your grant:
c) Leave the United States:
18. Plans After Completion of the Fellowship:
I certify that the information given in this application is complete and accurate to the best of my
knowledge. I understand that final approval of my application is dependent upon my eligibility to
receive the appropriate visa. I agree to return to the Czech Republic upon completion of the
fellowship.
Signature _______________________________ Date ______________________
Statement of Proposed Activity
Name:
Project Title:
Applicant should organize their proposals to address the following points either for research or for
lecturing.
RESEARCH
 Background: When possible, place the project in academic or professional context by referring to
the major work by others on a topic. In some cases this can be aided by use of a select
bibliography.
 Objectives: Define clearly the aims of the project.
 Methodology: Describe the project, and explain the approach and methods you will follow.
 Significance: Explain the significance of the project for the field, your own professional
development, and your home country.
 Evaluation and dissemination: Describe plans for assessment and dissemination of results both
in your home country and elsewhere.
Because applications are usually reviewed by multidisciplinary panels, you should describe your
project to the extent possible in terms accessible to scholars not in your field.
Detailed Project Statement
Do not exceed three pages (2,100 words). Please type, and use plain white paper for continuation
pages. Number each subsequent page.
Proshek-Fulbright Fellowship
Reference Report
Applicant should complete Parts I and III and then give this form to the referee.
PART I
Name of Applicant
Position
Department
Institution
City/Country
Name of Evaluator
Position
Department
Institution
City/Country
Period of Award (Months)
PROJECT SUMMARY
(Detailed project statement should be given to the referee before Part II is Completed.)
PART II
Referee should type and return immediately to the Fulbright administrative agency at the address
below. The reference must be written in English. Applications cannot be reviewed without reference
reports. This form must be received by the appropriate in-country deadline indicated below.
1. How long and in what capacity have you known the applicant?
2.
Please discuss the applicant’s qualifications and the merits of the proposal by commenting on the
a) applicant’s credentials, potentials, and record of academic or professional accomplishment;
b) significance of proposal to the field;
c) importance of project to home country; and
d) relevance of applicant’s previous research and training to proposed project.
3.
Please address the applicant’s cross-cultural adaptability and flexibility.
Date
Signature of Evaluator
PART III
DO NOT RETURN TO APPLICANT! RETURN COMPLETED REPORT TO
J. W. Fulbright Commission
Táboritská 23
130 87 Praha 3
NO LATER THAN:
1st February 2006
Proshek-Fulbright Fellowship
Reference Report
Applicant should complete Parts I and III and then give this form to the referee.
PART I
Name of Applicant
Position
Department
Institution
City/Country
Name of Evaluator
Position
Department
Institution
City/Country
Period of Award (Months)
PROJECT SUMMARY
(Detailed project statement should be given to the referee before Part II is Completed.)
PART II
Referee should type and return immediately to the Fulbright administrative agency at the address
below. The reference must be written in English. Applications cannot be reviewed without reference
reports. This form must be received by the appropriate in-country deadline indicated below.
3. How long and in what capacity have you known the applicant?
4.
Please discuss the applicant’s qualifications and the merits of the proposal by commenting on the
e) applicant’s credentials, potentials, and record of academic or professional accomplishment;
f) significance of proposal to the field;
g) importance of project to home country; and
h) relevance of applicant’s previous research and training to proposed project.
4.
Please address the applicant’s cross-cultural adaptability and flexibility.
Month/Day/Year
Signature of Evaluator
PART III
DO NOT RETURN TO APPLICANT! RETURN COMPLETED REPORT TO
J. W. Fulbright Commission
Táboritská 23
130 87 Praha 3
NO LATER THAN:
1st February 2006
Proshek-Fulbright Fellowship
Reference Report
Applicant should complete Parts I and III and then give this form to the referee.
PART I
Name of Applicant
Position
Department
Institution
City/Country
Name of Evaluator
Position
Department
Institution
City/Country
Period of Award (Months)
PROJECT SUMMARY
(Detailed project statement should be given to the referee before Part II is Completed.)
PART II
Referee should type and return immediately to the Fulbright administrative agency at the address
below. The reference must be written in English. Applications cannot be reviewed without reference
reports. This form must be received by the appropriate in-country deadline indicated below.
5. How long and in what capacity have you known the applicant?
6.
Please discuss the applicant’s qualifications and the merits of the proposal by commenting on the
i) applicant’s credentials, potentials, and record of academic or professional accomplishment;
j) significance of proposal to the field;
k) importance of project to home country; and
l) relevance of applicant’s previous research and training to proposed project.
5.
Please address the applicant’s cross-cultural adaptability and flexibility.
Month/Day/Year
Signature of Evaluator
PART III
DO NOT RETURN TO APPLICANT! RETURN COMPLETED REPORT TO
J. W. Fulbright Commission
Táboritská 23
130 87 Praha 3
NO LATER THAN:
1st February 2006