Claire M. Fagin Fellowship

2009 Fellowship Application Checklist

Please use the following checklist as you develop your application.  Items listed in the left hand column, are required elements for the Fellowship application.   The right column provides a description of each item.

Additional items are not accepted.  Submitting additional items or addenda may result in removing your application for consideration.

Below is the list of items to be provided and a description of each. As noted in the FAQ section, the process of completing an application may take much longer than anticipated; therefore, we encourage you to begin as soon as possible.

Data Sheet	Basic identifying information. Please note we require all applicants provide a second, permanent e-mail address.
Professional Development Plan for the fellowship period (5-7 pages double spaced, 12 point Arial, 1 inch margins in APA or AMA style)	The professional development plan must include:   (a) an introduction that traces your personal and professional interest in geriatric nursing, (b) research and leadership goals for the program, (c) research, teaching and leadership competencies to be attained during the program, (d) activities planned to develop the competencies - organized along a two year time line, (e) anticipated outcomes, e.g., how will you be a more effective researcher and leader in this area, and, (f) long-term (10 – 15 years) plans. “Where do you see yourself in 15 years?” Applicants choosing to remain at the same institution at which doctoral studies were completed must provide their rationale for continuing at that institution. Faculty members applying for a Fellowship and requesting to stay at their current institution must also provide their rationale for continuing at that institution. While some faculty commitments may be maintained, these should be relevant to the applicant’s work and sufficiently minimal and not be in conflict with the work the applicant is undertaking. Where such activities are to be undertaken they must be carefully and fully described in the application.        The length is a maximum 5-7 pages, not including the following three addenda: 1.  References (if applicable). 2.  Mentor/Consultant Information. A list including primary mentor, other mentors, and consultants as applicable. Include name, credentials, organization, and email for each person. 3. Response to Reviewers. If you have previously applied for a predoctoral scholarship and received feedback from the review committee, explain in two pages or less how you have addressed the issues raised by reviewers.
Research Proposal (maximum of 15 pages double spaced, not including references, 12 point Arial, 1 inch margins in APA or AMA style)	Describe the research which the applicant plans to undertake during the two-year fellowship.  Include (1) proposed aims, (2) background, (3) methods, and (4) potential significance in improving the healthcare of older adults and their caregivers. A maximum 15 pages, not including references.  No addendums other than references allowed.
Budget for each grant year. Format: You must use Excel budget format provided in online application system.	Provide a budget for grant year I and grant year II including details on funding utilization. The budget should contain a detailed research and funding timetable, beginning July 1, 2009 or no later than September 1, 2009 and ending June 30, 2011 or no later than August 31, 2011. Acceptable costs include tuition for special courses to enhance gerontological background, stipends, research assistance, supplies/equipment, and travel and registration costs for selected specialty focused meetings. Applicants must allocate funds for Primary Mentor travel and hotel for the Leadership Conference; Applicants must allocate funds for his/her GSA conference registration and hotel for the full GSA conference. Applicants must include all anticipated sources of funding. Budgets must be reviewed and approved by an appropriate official at the proposed institution of fellowship training prior to application submission. No indirect costs allowed.
Mentor /Consultant letter of commitment including  4-page NIH format bio-sketch. No specific format required for this letter. Letter can be addressed to the Program Director.	A letter from each mentor who will support and advise the applicant in implementing the scholarship program. If more than one mentor enlisted, please identify who will serve as the Primary Mentor during this fellowship. Include each mentor's NIH-formatted 4-page bio-sketch and outline of background and competencies; detailed proposal for involvement in the applicant's professional development; and ability to help the applicant form linkages with relevant colleagues and institutions. The Program reserves the right to call Mentor(s) for additional information. Please note that a primary mentor must be identified.
Letter of commitment from institution providing fellowship training. No specific format required for this letter. Letter can be addressed to the Program Director.	A letter signed by the Dean, or other appropriate administrator at the proposed institution providing fellowship training, that documents the school’s current capacity in geriatrics, i.e., curriculum, grants, faculty and other initiatives; an outline of institutional resources available to the candidate, e.g., secretarial support, technology; etc.  Letter should include a statement, indicating support for placement of the applicant at the institution and the Dean’s recognition that the fellowship is a full time equivalent commitment.
Letter of commitment from employing agency (if applicable) Note: if you have multiple letters, please scan or assemble into one PDF file before uploading. No specific format required for this letter. Letter can be addressed to the Program Director.	If the applicant is employed and plans to remain at the institution at which the fellowship will occur, the letter from the Dean must clearly stating specifically how the applicant will be freed from current responsibilities to allow full time commitment to the fellowship, and attesting to institutional support for the applicant’s current and future role in the institution or organization. If applicant holds a position at another institution, they must provide a letter from the employer indicating the applicant will be have sufficient release to allow for full time commitment to the fellowship activities.
Letter of support from practice/research site director where needed No specific format required for this letter. Letter can be addressed to the Program Director.	Letter in support for the applicant’s research from the Director of the site(s) in which the applicant’s proposed research will be undertaken, if such site is identified in the professional development plan or research proposal.
Applicant's Curriculum Vitae	Current document that includes education, professional experience, research, publications, special achievements, and professional service activities.
PhD Transcript(s)	We require the unofficial copy(ies) of your PhD program ONLY uploaded into the online application (please combine into one PDF if there is more than one). The sealed, official transcript(s) for the PhD program must be mailed to the Coordinating Center at the address at the end of this page. If you have transcripts from more than one institution, compile all official transcripts and send them in one package using a tracking service to be sure they are delivered to the Coordinating Center. If an institution will not release the official transcript to you, be sure it has the correct mailing address and follow up to ensure it is received. NOTE: - The unofficial uploaded version may be a printout from the university website. - If you have not been awarded your degree at the time of application, submit a transcript that incorporates all classes to date.
3 letters of reference (other than mentor(s)) No specific format required for this letter. Letter can be addressed to the Program Director.	The three references must speak to the potential of the candidate to succeed in the fellowship program and offer specific evidence of the candidate’s potential for academic and professional leadership in the field. Provide name, credentials, institution and email address for each reference. References will be completed online. The reference and the applicant will receive a confirmation email when the reference is completed and received.
Institutional signoff No specific format required for this letter. Letter can be addressed to the Program Director.	Letter/signoff from appropriate institutional office stating support for application to the program and agreement to administer the award. This letter/signoff is intended to be from the office that will handle the financial administration of the award.