First Name

    Last Name

    Email Address




    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).




    Zip Code


    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 one (1) copy of the completed application, supporting documents, and letters of recommendation to arrive no later than December 15 to the following address, or email one PDF copy of all application materials to

    The Rho Chi Society
    C/O University of Michigan, College of Pharmacy
    Attn: Clinical Research Scholarship Committee
    428 Church Street
    Ann Arbor, MI 48109-1065

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