13. Current 12. Current School Major(s)/Field(s) of Study One 14. How many years of your 15. Enrollment Month Two current academic program Date: Three Year will you have completed by May 2018? Four High School Diploma BA BS 17. Prior academic 16. academic MD major(s)/fields of degree/s study: PhD/DrPH MPH MA Other (specify) Cameroon 18. While the final countries for 2018 have not yet been finalized, they will likely include The Dominican Republic the five listed here (and possibly Ethiopia additional locations). Please indicate your preference for location by ranking them Kenya on a scale of 1-5. (1=1st choice; 2=2nd Lesotho choice; 3=3rd choice, etc. If no preference, check the preference” Swaziland “no row. No preference Spoken: Language 1 19. Language proficiency. Please list Written: languages in addition to English and Spoken: indicate your level of spoken and written Language 2 Written: proficiency. (e.g., fluent, conversant, Spoken: intermediate, beginning) Language 3 Written: 20. Describe prior research experience, if any. 21. Describe prior global health experience, if any. . For more information, please visit the ICAP website student center: or email Elizabeth Pierre at
12. Current School 13. Current Major(s)/Field(s) of Study 14. How many years of your current academic program will you have completed by May 2018? One 15. Enrollment Date: Month Two Three Year Four 16. academic degree/s High School Diploma 17. Prior academic major(s)/fields of study: BA BS MD PhD/DrPH MPH MA Other (specify) 18. While the final countries for 2018 have not yet been finalized, they will likely include the five listed here (and possibly additional locations). Please indicate your preference for location by ranking them on a scale of 1-5. (1=1st choice; 2=2nd choice; 3=3rd choice, etc. If no preference, check the “no preference” row. Cameroon The Dominican Republic Ethiopia Kenya Lesotho Swaziland No preference 19. Language proficiency. Please list languages in addition to English and indicate your level of spoken and written proficiency. (e.g., fluent, conversant, intermediate, beginning) Language 1 Spoken: Written: Language 2 Spoken: Written: Language 3 Spoken: Written: 20. Describe prior research experience, if any. 21. Describe prior global health experience, if any. For more information, please visit the ICAP website student center: or email Elizabeth Pierre at .
1._Program_Application_-_2018_MHIRT_Fellowship_FINAL.docx