application form

Application for the IRACDA/STRIDE Postdoctoral Program
Complete this application form and submit together with the following:
o Curriculum vitae, including publications to date
o A personal statement that discusses your:
l
l
l
l
l
l
Motivation to apply for the UCSF/SFSU STRIDE Program
Background, especially any obstacles you overcame to earn your doctoral degree
Research experience
Teaching experience, if any, and what inspires you to teach
Career plans after postdoctoral training
Ways in which you expect to contribute to diversity efforts in science and science education,
and any previous experience you have in such efforts
o Your official transcript should be sent directly from your graduate institution.
o Two letters of reference should be sent directly from your referees —
­­ one should be from your
dissertation advisor.
Name
PhoneEmail
Graduate Degree Institution
Degree type o PhD
o MD
o MD/PhD
Date expected or received
Dissertation Title
Anticipated start-date in STRIDE Program, if accepted
List three research mentors you are interested in working with at UCSF. (You may indicate any faculty member
at UCSF. You are not limited to current or previous STRIDE mentors.)
How did you hear about the STRIDE Program?
SignatureDate
IRACDA/STRIDE personal data form
Name
If you decline to provide the information below, it will not affect consideration of your application. Your
cooperation is appreciated.
Ethnic Origin (check one)
o Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish cultural or origin, regardless of race
o Not Hispanic or Latino
Racial Categories (check all that apply)
o American Indian or Alaska Native: A person having origins in any of the original peoples of North, Central,
or South America and maintains tribal affiliations or community attachment
o Asian: Having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
o Black or African American: Having origins in any of the Black racial groups of Africa
o Native Hawaiian or other Pacific Islander: Having origins in any of the original peoples of Hawaii, Guam,
Samoa, or other Pacific Islands.
o White: Having origins in any of the original peoples of Europe, the Middle East, or North Africa.
o Unknown
o Decline to state
(Note that, because of federal funding requirements, you must be a US citizen or permanent resident to be
eligible for the IRACDA/STRIDE Program.)
The deadline for applications is April 8, 2015 for postdocs starting in August 2015 or later.
Scholars accepted for the program may start at any time of year by agreement with their PI and the
program administrators.
Please send this application form, your CV, and personal statement in pdf format via email to:
Dr. Christine Des Jarlais, assistant dean for postdocs and career development, [email protected];
and copy: Erik Rotman, [email protected]. Letters of reference may be sent as attachments to email or
by regular mail, but must come directly from the referees, not from the applicant.
Official graduate transcripts should be sent directly from the applicant’s institution to:
Attn: Dr. Christine Des Jarlais, UCSF Graduate Division, Postdoc Office
1675 Owens Street, Campus Box 0523, San Francisco, CA 94143-0523
For further information, please contact Erik Rotman, tel. 415/514-4858 (email above).