DDCF CLINICAL RESEARCH FELLOWSHIP
PROGRAM FOR MEDICAL STUDENTS

Note: All fields marked with an * are required. Only one electronic application per applicant will be accepted.

You will receive a confirmation screen and e-mail after your submission has been received. If you are having difficulty, please contact us at ddcfcrf@aibs.org.

This form must be filled out and submitted electronically to DDCF. After you click "Submit," you will receive an email with all of the information you enter into the fields below. The personal statement will be an attachment to the email. Print the email and the attached personal statement and include it as the first pages of your application package for each medical school to which you apply (see Preparing Your Application Package for instructions on the other materials you will need to include). Completed application packages must be received at individual schools by January 16, 2008.

Please verify that you are on the secure application site by verifying that your browser is on https://www.ddcf.org/apps/crf/application2.asp before entering your information.


Applicant:

First Name * Last Name * Middle Name
Degree(s) *

School Year Address *
Phone * Mobile E-Mail Address *

Permanent Address *
Phone * E-Mail Address *

US Citizen or Permanent Resident: * Yes No

Education:
Undergraduate Institution *
City/State:
Dates Attended (From-To):
Level Completed:
Field of Study:

Medical School Currently Attending *
City/State:
Current year of medical school. *
When did you start your medical school clinical training? (YYYY)*

If you attended any graduate institution(s):

Graduate Institution
City/State:
Dates Attended (From-To):
Level Completed:
Field of Study:

Institution
City/State:
Dates Attended (From-To):
Level Completed:
Field of Study:

Institution
City/State:
Dates Attended (From-To):
Level Completed:
Field of Study:

Please identify the area(s) of clinical research of interest (press and hold the Ctrl or Apple key to select more than one option) *:
Other description:

Indicate the medical schools and program type (domestic and/or international) in the Doris Duke Clinical Research Fellowship Program to which you are applying. You can apply to more than one school (please note this information will be released to all schools to which you apply). *:
(Press and hold the Ctrl or Apple key to select more than one option).
 
On occasion, after first offers have been made, CRF schools you did not apply to may wish to contact you about available openings at their school. Please check this box if you agree to be contacted by a school to which you did not apply. By clicking this box, you indicate your understanding that your application information will be shared with this school. 
 

Are you attending one of the CRF Program Medical Schools? * Yes No
If so, which school? 
Are you applying to the school in which you are matriculated * Yes No
How did you hear about the DDCF Clinical Research Fellowship Program? *
Other: 

Names of Faculty who will write letters of support on your academic performance and potential for clinical research

Reference #1 *
Name * Title * Institution *
Address *
Phone * E-Mail Address *

Reference #2 *
Name * Title * Institution *
Address *
Phone * E-Mail Address *

Do you have any prior research experience? * Yes No
If so, please describe it briefly (no more than 50 words). Exceeding 50 words will result in an error.
Do you have any prior clinical research experience? * Yes No
If so, please describe it briefly (no more than 50 words). Exceeding 50 words will result in an error.

Personal Statement
Upload a word document containing a description of a) your reasons for undertaking clinical research; b) your plans for future professional or graduate education as well as your long-term career plans; and c) your current research interests, and the areas or questions that you would like to explore through the fellowship?) Limit to 6000 characters, including spaces (1.5 pages). *

After you submit this form, assemble the other materials required for your application package and mail the completed package directly to the schools to which you are applying. A complete application package includes hard copies of the following:

Preview Your Application Data

Pressing 'Preview' below will move you to the next step, where you will preview the application information you are submitting. You may also click the 'Clear this Form' button to start again. If you are having difficulty, please contact us at ddcfcrf@aibs.org.

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