Single Application Single Applicant From 2026 - 27DemographicsFirst NameLast NameAddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweBirth DatePersonal PronounsPhone Number EmailEducationWill you be enrolled in a degree-granting program through April 2027? Yes NoWhat year in your degree program will you be during the 2026-2027 academic year?When is your expected graduation date?Your School- Select -Alabama State UniversityAuburn UniversitySamford University, College of Health SciencesTuskegee UniversityUAB School of DentistryUAB School of Health ProfessionsUAB Heersink School of MedicineUAB School of NursingUAB School of OptometryUAB School of Public HealthUniversity of MontevalloUniversity of AlabamaOther:DisciplineDegree ProgramHow do you plan to balance the demands of the Fellowship with your academic and personal responsibilities?INTERVIEW SCHEDULINGInterviews will be held on February 4th and 5th virtually and will last about 30 minutes (or 45 minutes for partnered applicants). Please indicate your availability here by checking any timeslot that you can NOT attend. We will automatically assign interview timeslots and notify you around January 30th if you’ve received an interview and when the interview will take place. Again, check boxes that do NOT work; do not check boxes that you would be available.Again, select options that do NOT work; do not select options that you would be available.5-6 p.m. Wednesday, February 4th6-7 p.m. Wednesday, February 4th7-8 p.m. Wednesday, February 4th5-6 p.m. Thursday, February 5th6-7 p.m. Thursday, February 5th7-8 p.m. Thursday, February 5thAre there any scheduling conflicts that would prevent you from participating in trainings or meetings? Please indicate any times you anticipate being out of the area and/or unable to participate in Fellowship activities.Can you commit to 200 service hours and participation in monthly trainings/coaching sessions over the Fellowship year? Yes NoINTEREST AREAS & PERFORMANCE MEASURESEach year, ASF of Alabama works to balance responsiveness to community needs with the interests and passions of our applicants. Research shows that health outcomes are shaped not only by clinical care and health behaviors, but also by social, economic, and environmental factors.To guide Fellows, ASF uses a results framework so that every activity is connected to a defined goal.In this section, you’ll be asked to share two project ideas that interest you. For each idea, please include: the topic and performance measure; a description of the need; your project idea; possible community partner site(s); and how you might address this need through a Fellowship project.You are not committing to either of these ideas, and you do not need confirmation from the potential site partners at this stage. This exercise simply helps us understand how you think about community needs and solutions.Project Idea #1Here, please describe your first idea. You are not committing to undertake either of these ideas and you do not need a commitment yet from the site partner listed; it's just a way to see how you think about community needs.What topic would your project address (#1)? Describe a potential strategy you might use to address this topic (#1)?Why do you care about this social issue and what is your relationship to those who are impacted by this need? (#1)Name 1 or more possible community site partners and describe how this project would align with their mission and goals. (#1)How would you ensure your project is responsive to the voices and experiences of the community you plan to serve? (#1) Project Idea #2Here, please describe your second idea. You are not committing to undertake either of these ideas and you do not need a commitment yet from the site partner listed; it's just a way to see how you think about community needs.What topic would your project address? (#2)Describe a potential strategy you might use to address this topic. (#2)Why do you care about this social issue and what is your relationship to those who are impacted by this need? (#2)Name 1 or more possible community site partners and describe how this project would align with their mission and goals (#2)How would you ensure your project is responsive to the voices and experiences of the community you plan to serve? (#2)APPLICANT PERSONAL & PROFESSIONAL INFORMATION AS IT RELATES TO FELLOWSHIP ACTIVITIESSome description about this sectionWhy are you applying for this Fellowship?How does this Fellowship align with your personal and professional goals?What would you hope to learn (knowledge or skills) during your fellowship year? Do you have any prior experience working with underserved communities? If so, please describe.Optional Personal Statement: Please include anything else about your personal and professional background that you would like to share with the selection committee REFERENCES, INCLUDING ACADEMIC MENTORPlease provide the names and contact information for two individuals. For Reference #1, applicants should have identified a faculty member who agrees to support you during the year as outlined in the Academic Mentor Agreement (found on our website under “Become a Fellow"). For Reference #2, include anyone else who can attest to your character, either due to personal, academic, or work experience. You do NOT need to submit letters of recommendation from either person, however, we may contact them for a reference check.Refernce 1 - Academic MentorSome description about this sectionFirst NameLast NamePhone NumberEmailReference 2 Some description about this sectionFirst NameLast NamePhone NumberEmailAGREEMENT TO ASF REQUIREMENTSBy 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 [or possibly less if a partner project] towards planning and implementing the project (June 2025-April 2026). 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 Orientation (April 12-13, 2025) and 80% or more of the monthly meetings, completing the service hours, conducting Pre/Post-Surveys, and submitting a Final Report.Do you agree to these requierments? Yes NoSubmit Form