Apply Now Applicant Information Name First Last Email Phone Address Address line 1 Address line 2 City State Zip Code Education Enrollment YesNo Will you be enrolled in a degree-granting program through April 2021? Program Year FirstSecondThirdFourthOther What year in your degree program will you be during the 2020-2021 academic year? Expected Graduation Date Your School Your Discipline Degree Program Availability Fellows are expected to participate in Fellowship activities throughout the 15-months (January 2020 - April 2021). To achieve the 200+ hours of service required, it will take an average of 4-5 hours/week. How do you plan to balance your commitment to ASF service hours while maintaining successful progress in your academic program? Schedule Please indicate any times you anticipate being out of the area and/or unable to participate in Fellowship activities for reasons other than those listed above. Interest Areas Which of the following are you most likely to address with your Schweitzer Fellowship project? CHOOSE THREE to FIVE. Access to Care (e.g., uninsured; primary care, dentists, and mental health providers)Air and Water QualityAlcohol and Drug UseCommunity Safety (e.g., violent crime; injury deaths)Diabetes PrevalenceDiet and ExerciseDrug Overdose DeathsEducationEmploymentFamily and Social SupportFood Insecurity or Limited Access to Healthy FoodHIV PrevalenceHousing and TransitIncomeInfant Mortality or Child MortalityInsufficient SleepMotor Vehicle Crash DeathsOral HealthQuality of Care (e.g., preventable hospital stays; diabetes monitoring; mammography screening)Quality of Life (e.g., Low birthweight; poor mental health; poor physical health)Sexual Activity (e.g., sexually transmitted infections; teen births)Tobacco UseOther (describe below) Describe three specific problems within one or more of these topic areas that is relevant in your local community AND explain why this population or area of unmet need interests you. * Label them A, B, and C. (Suggested word limit - 1 paragraph for each A, B, and C) Project Planning Bearing in mind that the majority of your ASF service hours should be spent in direct face-to-face community service, describe a potential way that each of the ideas above (A, B, and C) could be addressed through a fellowship project. [You are not committing to undertake any of these ideas, it's just a way to see how you think about community problems.] (Suggested word limit - a brief paragraph for each idea) Interest Why does this population or area of unmet need interest you? Applicant Personal & Professional Information as It Relates to Felowship Activities Inspiration for pursuing ASF What inspires you to participate in the Schweitzer Fellowship (suggested word limit - 1 paragraph)? Personal Growth Tell us about a time in which you failed or faced a major obstacle but persevered. (Suggested word limit - 1 paragraph) Learning Goals What would you hope to learn (knowledge or skills) during your fellowship year? (Suggested word limit - 1 paragraph) Teamwork Tell us about your personal experience with being part of a team (academic, extra-curricular, etc.). How did you contribute to the team? (Suggested word limit - 1 paragraph) Personal Statement Please include anything else about your personal and professional background that you would like to share with the selection committee (Suggested word limit - maximum of 3 paragraphs). References Please provide the names and contact information for two individuals who can attest to your character, either due to personal, academic, or work experience. You do NOT need to submit letters of recommendation from them. Rather, we may contact them for a reference check. Reference #1 First Name Last Name Phone Email Reference #2 First Name Last Name Phone Email Resume/CV Please upload your resume (limit 2 pages) I agree to ASF requirements. By applying to ASF, you understand that successful progress in the program requires Fellows to identify a community site (by April), plan a project (by June), and conduct 200+ hours towards planning and implementing the project (June 2020-April 2021). You also understand that a background check will be run on all who are selected prior to beginning service hours. The stipend is contingent on meeting certain benchmarks throughout the program year, including attending 80% or more of the monthly meetings, completing the service hours, conducting Pre/Post-Surveys, and submitting a Final Report.