Apply – Alabama Schweitzer Fellowship

Applicant #1 Information

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Personal pronouns *

(e.g., he/him, she/her, they/them)

Applicant #2 Information

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Personal pronouns *

(e.g., he/him, she/her, they/them)

Education- Applicant #1

Enrollment *

Will you be enrolled in a degree-granting program through April 2025?

Program Year *

What year in your degree program will you be during the 2024-2025 academic year?

Expected graduation date? *

Your School *

Please select your school; if Other, include the name below next to your discipline

Your Discipline *

Degree Program *

Balancing Commitments *

Fellows are expected to participate in Fellowship activities throughout the 14-months (February 2024 – April 2025). To achieve the 200+ hours of service required, it will take an average of 4-5 hours/week. [Note: those applying as a partner project must do a minimum of 100 hours of direct service each and share the time for planning, which means it may total less than 200 hours each, with a prorated stipend.] How do you plan to balance your commitment to ASF service hours while maintaining successful progress in your academic program?

Schedule Availability *

Please indicate any times you anticipate being out of the area and/or unable to participate in Fellowship activities.

INTERVIEW Availability

Tuesday, January 23rd (5-8pm)
Wednesday, January 24th (12-2:30pm)
Wednesday, January 24th (2:30-5:00pm)
Wednesday, January 24th (5-8pm)

Interviews will be held on January 23rd and 24th virtually and will last about 45 minutes. Partners will interview together. Please indicate your availability here by checking ALL timeslots that you could likely attend. We will automatically assign interview timeslots and notify you around January 16th if you’ve received an interview and when the interview will take place. Again, check boxes that DO work; do not check boxes that you would be unavailable.

Education- Applicant #2

Enrollment *

Will you be enrolled in a degree-granting program through April 2025?

Program Year *

What year in your degree program will you be during the 2024-2025 academic year?

Expected graduation date? *

Your School *

Please select your school; if Other, include the name below next to your discipline

Your Discipline *

Degree Program *

Balancing Commitments *

Schedule Availability *

Please indicate any times you anticipate being out of the area and/or unable to participate in Fellowship activities.

Interest Areas & Performance Measures

Each year, ASF of Alabama seeks to be responsive to community needs while also honoring the interests of applicants. Research shows that health outcomes are a product of health behaviors, clinical care, social and economic factors, and the physical environment. ASF also uses a results framework, so that activities you conduct are directed towards a specific goal. Below, you will share two ideas that interest you. For each, tell us the need, performance measure, project idea, possible community partner site(s), and a way that you could address this need through a fellowship project. 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.

Project Idea #1

Here, 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.

Topic and Performance Measure *

Which of the following would you likely be working towards as the outcome of your project?

Describe the specific need related to the topic and goal selected above *

1-2 sentences

Potential ways that this goal could be achieved *

Up to 5 sentences

Why do you care about this social issue and what is your relationship to those who are impacted by this need? *

Up to 5 sentences

Name 1 or more possible community site partners and describe why you believe this project would align with their mission and goals *

How could you center your effort around those who will benefit the most from this collaboration? For example, how might you ensure that those with lived experience are included in developing and testing your idea? *

Up to 5 sentences

Project Idea #2

Here, 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.

Topic and Performance Measure (#2) *

Which of the following would you likely be working towards as the outcome of your project?

Describe the specific need related to the topic and goal selected above (#2) *

1-2 sentences

Potential ways that this goal could be achieved (#2) *

Up to 5 sentences

Why do you care about this social issue and what is your relationship to those who are impacted by this need? (#2) *

Up to 5 sentences

Name 1 or more possible community site partners and describe why you believe this project would align with their mission and goals (#2) *

Up to 5 sentences

Applicant Personal & Professional Information as it Relates to Fellowship Activities

In the spaces below, answer the questions and indicate who it is from (e.g., Name 1- Answer…; Name 2- Answer…)

Inspiration for pursuing ASF *

What inspires you to participate in the Schweitzer Fellowship (suggested word limit – 1 paragraph each)?

Personal Growth *

Tell us about a time in which you failed or faced a major obstacle. How did you respond? (Suggested word limit – 1 paragraph each)

Learning Goals *

What would you hope to learn (knowledge or skills) during your fellowship year? (Suggested word limit – 1 paragraph each)

Teamwork *

Tell us about your personal experience with being part of a team (academic, extra-curricular, etc.) where you had to advance a project or task. How did you contribute to the team? (Suggested word limit – 1 paragraph each)

Personal Statement

Optional- 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 each).

References

Please provide the names and contact information for three 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 References #2 & 3, include anyone else who can attest to your character, either due to personal, academic, or work experience with one for each partner. You do NOT need to submit letters of recommendation from them. Rather, we may contact them for a reference check.

Name- Reference #1 (Academic Mentor) *

First

Last

Phone *

Email *

Name- Reference #2 *

First

Last

This person should know Applicant #1.

Phone #2 *

Email #2 *

Name- Reference #3 *

First

Last

This person should know Applicant #2.

Phone #3 *

Email #3 *

Resume/CV- Partners *

Click or drag files to this area to upload. You can upload up to 2 files.

Please upload your resumes (limit 2 pages each, so up to 4 pages total once partners merge theirs into one pdf)

Attestations

Agreement to ASF Requirements *

Yes, I agree to these requirements
No, I do not agree to these requirements

By applying to ASF, you both 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 2024-April 2025). 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.

Agreement to Safety Precautions *

Yes, I agree to document my vaccination status, or to recurring testing (at my own cost) or a virtual project
No, I do not agree to these safety requirements

By applying to ASF, you both understand that precautions related to COVID and other disease mitigation will be instituted to protect you and individuals at your community site. Fellows are encouraged to be fully vaccinated and will be asked to document full and up-to-date vaccination status per any CDC guidelines. Should a Fellow not wish to show evidence of vaccination, they will be asked to conduct a project virtually or to pursue recurring testing in order to ensure safety.

Name

Applicant Information

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Personal pronouns *

(e.g., he/him, she/her, they/them)

Education

Enrollment *

Will you be enrolled in a degree-granting program through April 2025?

Program Year *

What year in your degree program will you be during the 2024-2025 academic year?

Expected graduation date? *

Your School *

Please select your school; if Other, include the name below next to your discipline

Your Discipline *

Degree Program *

Balancing Commitments *

Schedule Availability *

Please indicate any times you anticipate being out of the area and/or unable to participate in Fellowship activities.

INTERVIEW Availability *

Tuesday, January 23rd (5-8pm)
Wednesday, January 24th (12-2:30pm)
Wednesday, January 24th (2:30-5:00pm)
Wednesday, January 24th (5-8pm)

Interviews will be held on January 23rd and 24th virtually and will last about 30 minutes. Please indicate your availability here by checking ALL timeslots that you could likely attend. We will automatically assign interview timeslots and notify you around January 16th if you’ve received an interview and when the interview will take place. Again, check boxes that DO work; do not check boxes that you would be unavailable.

Interest Areas & Performance Measures

Each year, ASF of Alabama seeks to be responsive to community needs while also honoring the interests of applicants. Research shows that health outcomes are a product of health behaviors, clinical care, social and economic factors, and the physical environment. ASF also uses a results framework, so that activities you conduct are directed towards a specific goal. Below, you will share two ideas that interest you. For each, tell us the topic and performance measure, describe the need, project idea, possible community partner site(s), and way that you could address this need through a fellowship project. 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.

Project Idea #1

Topic and Performance Measure *

Which of the following would you likely be working towards as the topic and outcome of a project? Select from the drop-down menu.

Describe the specific need related to the topic and goal selected above. *

Brief- 1-2 sentences

Potential way that this goal could be achieved *

Up to 5 sentences

Why do you care about this social issue and what is your relationship to those who are impacted by this need? *

Up to 5 sentences

Name 1 or more possible community site partners and describe how this project would align with their mission and goals *

Up to 5 sentences

Project Idea #2

Topic and Performance Measure #2 *

Which of the following would you likely be working towards as the topic and outcome of a project? Select from the drop-down menu.

Describe the specific need related to the topic and goal selected above. (#2) *

Brief- 1-2 sentences

Potential way that this goal could be achieved (#2) *

Up to 5 sentences

Why do you care about this social issue and what is your relationship to those who are impacted by this need? (#2) *

Up to 5 sentences

Name 1 or more possible community site partners and describe how this project would align with their mission and goals (#2) *

Up to 5 sentences

Applicant Personal & Professional Information as it Relates to Fellowship Activities

Inspiration for pursuing ASF *

What inspires you to participate in the Schweitzer Fellowship (suggested word limit – 1 paragraph)?

Learning Orientation *

What practices do you use to learn and improve your effectiveness? (Suggested word limit – 1 paragraph)

Personal Growth *

Tell us about a time in which you failed or faced a major obstacle. How did you respond? (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 *

Personal Statement

Optional: 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, including Academic Mentor

Please 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.

Name- Reference #1 (Academic Mentor) *

First

Last

Phone *

Email *

Name- Reference #2 *

First

Last

Phone *

Email *

Resume/CV *

Click or drag a file to this area to upload.

Please upload your resume (limit 2 pages)

Attestations

Agreement to ASF Requirements *

Yes, I agree to these requirements
No, I do not agree to these 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 2024-April 2025). 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.

Agreement to Safety Precautions *

Yes, I agree to document my vaccination status, or to recurring testing (at my own cost) or a virtual project
No, I do not agree to these safety requirements

By applying to ASF, you understand that precautions related to COVID and other disease mitigation will be instituted to protect you and individuals at your community site. Fellows are encouraged to be fully vaccinated and will be asked to document full and up-to-date vaccination status per any CDC guidelines. Should a Fellow not wish to show evidence of vaccination, they will be asked to conduct a project virtually or to pursue recurring testing in order to ensure safety.

Name

Application

Applicant #1 Information

Applicant #2 Information

Education- Applicant #1

Education- Applicant #2

Interest Areas & Performance Measures

Project Idea #1

Project Idea #2

Applicant Personal & Professional Information as it Relates to Fellowship Activities

References

Attestations

Applicant Information

Education

Interest Areas & Performance Measures

Project Idea #1

Project Idea #2

Applicant Personal & Professional Information as it Relates to Fellowship Activities

References, including Academic Mentor

Attestations

asf_alabama