Claire M. Fagin Fellowship

2014 Claire M. Fagin Postdoctoral Fellow Award
Application Checklist

As you work to complete this application, please keep in mind the following:

• You must use the naming conventions outlined below for naming your electronic files
• Submitting additional items or exceeding page limits will result in removing your application from consideration

There are 3 major components to be submitted:

1. The Application (described below) to be uploaded in our Dropbox on the Filesanywhere website as a single PDF document. The file should be named Candidate Last Name_ Candidate First Name_ Fellow Application

2. Three references, each including the two components described in section 2 below, to be uploaded as a PDF document in our Dropbox. Each of the references should name the document uploaded Candidate Last Name_ Candidate First Name_ Reference Last Name_ Fellow Application

3. Official transcripts to be sent to:

NHCGNE Coordinating Center
1220 L Street NW, Suite 901
Washington, DC 20005

1. The APPLICATION consists of the following items:

A. Table of Contents

B. Data Sheet

C. Proof of Residency
If you are not a US citizen, a photocopy of your permanent residency visa (green card).

D. Curriculum Vitae
Current document that includes education, professional experience, research, publications, special achievements, and professional service activities.

E. Professional Development Plan
1. Format:
Five to seven pages double spaced, 12 point Arial, 1 inch margins using APA or AMA format. Only the 4 addenda described may be included. Items that are identified as required to be in the Plan must be in the Plan itself and not in an addenda.

2. The professional development plan must include:

a. An introduction that traces your personal and professional interest in gerontological nursing
b. A summary of relevant training and experience
c. The proposed institution for study and reason for choosing that institution
d. Identified Mentor(s) and why his or her background is appropriate for the applicant's program of research
e. Research, teaching and leadership competencies to be attained during the program
f. Work plan and timeline: activities planned to develop the competencies plotted along a two year timeline, including the applicant's program of study and attendance at Leadership Conferences and GSA meetings in 2014 and 2015
g. Fellows are not permitted to work more than .5 FTE during the award period. Where some work activities are to be undertaken during that time, they must be carefully and fully described in the Application.
h. An explanation of how you could arrange your other responsibilities so you can commit full time effort to the program
i. Long-term plans: "Where do you see yourself in 5, 10 and 15 years?"

3. Addenda

a. Citations (if applicable)
b. Mentor/Consultant Information (required)
A list including primary mentor, other mentors, and consultants as applicable which includes name, credentials, organization, and email for each person
c. Consultants' letters of commitment (if applicable)
d. Response to Reviewers (if applicable)
If you previously applied for a predoctoral award and received feedback from the review committee, explain in two pages or less how you addressed the issues raised by reviewers.

F. Research Proposal

1. Format:
A maximum of 15 pages double spaced, not including references, 12 point Arial, 1 inch margins using APA or AMA format. No addendums other than references are allowed.
2. 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.

G. Budget
Awards will total $120,000 (a maximum of $60,000 per annum) to each selected Fagin Fellow with the requirement that 10% of that amount be contributed by the institution where the Fellow is located (the “institutional match”). This contribution may be in the form of tuition waivers, research assistantships, teaching assistantships, grants-in-aid or Fellowships. Neither in-kind support nor student loans are acceptable as matching funds. No indirect costs are allowed to the school and waivers of these indirect costs cannot be considered matching funds.

Using the form provided applicants must provide a budget for year I and year II, including the 10% institutional match. Fellows must include the cost of travel, registration and hotel to attend the GSA Annual Scientific Meeting. They are also required to support the travel expenses for their Primary Mentor to attend the Leadership Conference. (Note: 2013 Fellows will be required to pay for their travel to the Leadership Conference which is a new policy.) The Coordinating Center directly covers the applicant's registration and hotel for participation in the Leadership Conference and therefore these expenses should not be included in this budget.

The budget may include the following items: tuition for special courses to enhance gerontological or research background, travel to relevant conferences, and items in support of your research. Foreign travel is not an acceptable expense and no indirect costs are allowed.

Applicants may request an additional $5,000 Mayday Award which may be used over the two year term, if research focuses on pain in older adults. A separate budget is required; see Mayday tab on Excel budget format.

Applicants must include all anticipated sources of funding (e.g. NRSA). Budgets must be reviewed and approved by an appropriate official at the proposed institution of study prior to application submission.

H. List of References
Provide name, credentials, institution and email address for each of the three individuals (other than mentors) who have agreed to provide a reference.

I. List of Transcripts
Please provide a list of all transcripts to be sent.

J. Mentor Commitment Letter(s) Including Bio-Sketch
Each mentor who will support and advise the applicant in implementing the Fellowship program must provide a letter of commitment. If more than one mentor is enlisted, applicant MUST identify who will serve as primary mentor in the Professional Development Plan.

Mentor letters should include a detailed proposal for involvement in the applicant's professional development; and strategies to help the applicant form linkages with relevant colleagues and institutions. Include each mentor's NIH-formatted 4-page bio-sketch.

NHCGNE reserves the right to contact the mentor(s) for additional information.

K. Institution of Study Commitment Letter
Submit a letter of commitment signed by the Dean or other appropriate administrator at the proposed institution of study 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 the applicant at the institution.

L. Institutional Application Approval
A signed letter from the appropriate institutional office approving the application to the Claire M. Fagin Predoctoral Fellow Award Program, including the proposed budget. This letter/signoff must be from the office that will handle the financial administration of the award.

M. Employer Commitment Letter (if required)
If the applicant is employed, please provide a letter from the employer indicating that the applicant will be given sufficient release tie to allow for fulltime commitment to the fellowship activities.

N. Practice/Research Site Commitment Letter (if applicable)
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.

2. LETTERS OF REFERENCE
Three references (other than the mentor(s)) who can speak to the applicant's potential to succeed in the Fellowship program and offer specific evidence of the candidate's potential for academic and professional leadership in the field.

The references are confidential and are composed of two elements:

1. A formal letter of reference and
2. An Applicant Evaluation Form

Each reference should be uploaded as a PDF document and should be named Candidate Last Name_ Candidate First Name_ Reference Last Name_ Fellow Application

3. TRANSCRIPTS
We ONLY require transcripts from your PhD program.

The sealed, official transcript(s) must be mailed to the Coordinating Center at 1220 L Street NW, Suite 901, Washington, DC 20005. When possible have all official copies sent to you, and when you have them all gathered, forward them to the Coordinating Center in one package using a mail service that allows you to track your package. If an institution will not release the official transcript to you, be sure they have the correct mailing address and we recommend you follow up to ensure it arrives.