HSAC Fellowship Application Form

Complete the following application form to be considered for the HSAC Fellowship Program. 
IMPORTANT: You must complete the application in one sitting, and cannot save for continuation later. Expected time to complete application is 30-45 minutes. 

In order for your application to be considered complete, this form needs to be submitted with all required information. Additionally, we must receive your research proposal and (3) letters of recommendation by email to admin@hsacouncil.org

The deadline to submit all required documents is: DATE


Basic Information
Name *
Name
Address *
Address
Phone *
Phone
Professional Experience
Please list your most relevant professional experience below. Up to three, starting with most recent.
Start Date *
Start Date
End Date
End Date
Leave blank if still currently employed.
Supervisor Phone Number
Supervisor Phone Number
Start Date
Start Date
End Date
End Date
Leave blank if still currently employed.
Supervisor Phone Number
Supervisor Phone Number
Start Date
Start Date
End Date
End Date
Leave blank if still currently employed.
Supervisor Phone Number
Supervisor Phone Number
Educational Background
Please choose highest level of education obtained.
Please list any relevant degrees and certifications:
Complettion Date
Complettion Date
Completion Date
Completion Date
Completion Date
Completion Date
Proposed Research
Fellowship Category *
Please choose which category your proposed research is most related to. May select more than one option.
Research Length *
Please indicate your proposed time of research. Note: this will not effect your eligibility for the fellowship program.
Research Proposal *
As part of your application, you must submit a separate research proposal by email to admin@hsacouncil.org by the application deadline. The proposal should detail your specific interests, professional goals, and what you intend to accomplish in the fellowship. Additionally, your proposal should include the problem statement you intend to investigate, research questions, hypothesis, research methodologies, and your proposed final deliverable (i.e. white paper, program evaluation, training course, etc.).
Letters of Recommendations
Please list the three individuals that will be submitting a letter of recommendation on your behalf. It is your responsibility that your recommenders know that they must submit their letters by email to admin@hsacouncil.org by the application deadline. HSAC will notify applicants when a letter of recommendation has been received.
Recommender *
Recommender
Phone *
Phone
Recommender *
Recommender
Phone *
Phone
Recommender *
Recommender
Phone *
Phone
Please note that pressing the submit button below will send information to HSAC immediately. You will not be able to go back and make any changes, so please review before submitting. Remember that in order for your application to be considered complete, we must receive your proposal and three letters of recommendation (directly from the recommenders) by email to admin@hsacouncil.org