Fellowship Application Please select a fellowship: * ...National Cancer Reporting FellowshipAHCJ-CDC Health Journalism FellowshipReporting Fellowship on Health Care PerformanceNLM Health Journalism FellowshipFellowship on Women’s HealthFellowship on Comparative Effectiveness ResearchInternational Health Study FellowshipNew York Health Journalism Fellowship (statewide)Colorado Health Journalism FellowshipAHCJ Freelance Travel Scholarship Name * Middle name Last name * Professional title * Twitter name (optional — one name only, please) Are you or have you been a member of AHCJ? * Yes No If yes, please provide the name on your membership: Affiliation / Employer / University * County of affiliation or residence * ...AlleganyCattaraugusCayugaChautauquaCortlandErieGeneseeHerkimerMadisonNiagaraOneidaOnondagaOrleansOswegoTompkinsWyoming County of affiliation or residence (statewide) * ...AlbanyAlleganyBronxBroomeCattaraugusCayugaChautauquaChemungChenangoClintonColumbiaCortlandDelawareDutchessErieEssexFranklinFultonGeneseeGreeneHamiltonHerkimerJeffersonKingsLewisLivingstonMadisonMonroeMontgomeryNassauNew York CityNiagaraOneidaOnondagaOntarioOrangeOrleansOswegoOtsegoPutnamQueensRensselaerRichmondRocklandSt. LawrenceSaratogaSchenectadySchoharieSchuylerSenecaSteubenSuffolkSullivanTiogaTompkinsUlsterWarrenWashingtonWayneWestchesterWyomingYates Mailing address * City * State / Province / Region * Postal code * Country Cell phone * Work phone (optional) Email address * Primary medium * ...NewspaperTelevisionOnlineMagazineRadioNewsletterBooksAcademicWire Service Mixed If you choose “Mixed” you must ALSO mark your primary outlet medium. Demographics Female Male African American/BlackAmerican Indian/Alaska NativeAsianHispanic/LatinoMultiracial/MixedPacific IslanderWhiteOther Please help us determine the diversity of our membership. Experience * 1 year or less 2-5 years 6-10 years 11-15 years 16-20 years 21+ years Citizenship * I am a U.S. citizen. I am not a U.S. citizen. Date of birth Place of birth 1. Please attach a brief cover letter (PDF only) telling us about yourself, your understanding of the fellowship and why you are applying for this fellowship (PDF, max. 5 MB). * 2. Please attach a current resume (PDF, max. 5 MB). * 3. Please attach a letter of recommendation from a current supervisor (PDF, max. 5 MB). * This letter should comment on your strengths and the likelihood that you and your employer will benefit from the fellowship. The letter should pledge the organization will support the applicant attending training sessions. Freelance applicants should include a recommendation from an assigning editor or client. 4. Please provide a URL to one story you published or aired during the 12 months preceding the application deadline. If no URL is available, you may attach a PDF or MP3 — max. 25 MB. We strongly encourage video broadcasters to upload their material to a service such as YouTube for review if it is not already available online. Note that YouTube allows “unlisted” posting. 5. Please attach a detailed project proposal (two to three pages) outlining the stories you want to pursue; potential sources; potential sites you want to visit through field reporting; what you could illustrate or illuminate for your readers, viewers or listeners; and what elements you envision in your final presentation (PDF, max. 5 MB). * Please provide two additional stories as described above in #4, either URLs or attachments (PDF or MP3, max. 25 MB).