Clinical Research Scholarship Form

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First Name

Last Name

Email Address

Address

City

State

Zip Code

Home Phone

Work Phone

Rho Chi Chapter

Year of Initiation

Fellowship Director

Director's Email

Address where you may be reached during the summer months (if different than above).

Address

City

State

Zip Code


References

Provide names of three individuals who will provide letters of reference. Letters of reference or recommendation should be from individuals directly familiar with you and should speak specifically to your educational achievements and your capacity for graduate study. All letters should be mailed directly to the Society’s National Office marked Attention: Chair of the Clinical Research Scholarship Committee.


Supporting Documents (on separate sheets)

  1. Submit transcripts from all colleges or universities attended (photocopies are acceptable).

  2. Provide your present title and affiliation and provide an abbreviated description of your fellowship program. (Maximum 2 pages)

  3. Enclose your Curriculum Vitae

  4. Briefly describe any previously completed (undergraduate or pre-doctoral) research projects. (Maximum 2 pages)

  5. List any research-related poster or platform presentations, published abstracts, and/or published articles. (Maximum 2 pages)

  6. Provide a narrative that addresses what you expect to accomplish during the second year of your fellowship, the projected impact of your work, and how your fellowship work relates to your career goals. (Maximum 3 pages)


Mail three (3) copies of the completed application, supporting documents, and letters of recommendation to arrive no later than December 15 to:

The Rho Chi Society
C/O UNC School of Pharmacy
Attn: Clinical Research Scholarship Committee
3210 Kerr Hall, CB#7569
University of North Carolina at Chapel Hill
Chapel Hill, NC 27599-7569


You will be notified by email when the completed application has been received.