Partner Application 26 – 27 Partner Applicant From 2026 - 27Applicant One DemographicsFirst 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 EmailApplication One EducationWill you be enrolled in a degree-granting program through April 2028? Yes NoWhat year in your degree program will you be during the 2027-2028 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?Application Two DemographicsFirst 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 EmailApplication Two EducationWill you be enrolled in a degree-granting program through April 2028? Yes NoWhat year in your degree program will you be during the 2027-2028 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 9th-11th virtually and will last about 30 minutes (or 45 minutes for partnered applicants). Partners will interview together. Please check with your partner and indicate your availability here by checking any timeslot that you can NOT attend. We will automatically assign interview timeslots and notify you around February 2nd 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. Tuesday, February 9th6-7 p.m. Tuesday, February 9th7-8 p.m. Tuesday, February 9th5-6 p.m. Wednesday, February 10th6-7 p.m. Wednesday, February 10th7-8 p.m. Wednesday, February 10th5-6 p.m. Thursday, February 11th6-7 p.m. Thursday, February 11th7-8 p.m. Thursday, February 11thAre 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 ACTIVITIESThe following questions should be answered separately by each applicant. For each response, please include the name of the applicant whose answer is being provided so we can clearly identify which response corresponds to each applicant.Why 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 three references: Reference #1 – Academic Mentor:Identify a faculty member who has agreed to support you throughout the Fellowship year as outlined in the Academic Mentor Agreement, available on our website under “Become a Fellow.” This individual will serve as the Academic Mentor for both applicants. Reference #2 – Reference for Applicant #1:Applicant #1 should identify one individual who can speak to their character based on personal, academic, or professional experience. Reference #3 – Reference for Applicant #2:Applicant #2 should identify one individual who can speak to their character based on personal, academic, or professional experience. You do not need to submit letters of recommendation. However, ASF Alabama may contact the individuals listed to conduct a reference check.Refernce 1 - Academic MentorFirst NameLast NamePhone NumberEmailReference 2 - Reference for Applicant 1First NameLast NamePhone NumberEmailReference 3 - Reference for Applicant 2First 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 2027-April 2028). 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 11-12, 2027) and the bimonthly training sessions, completing the service hours, conducting Pre/Post-Surveys, and submitting a Final Report.Do you agree to these requierments? Yes NoHave you attended a virtual info session or met with ASF staff? Attended a virtual info session Met with ASF staff Attended info session and met with staff NoSubmit Form