CBM Research Training Application Form

Only applicants for postdoctoral fellowships are required to submit this form with their applications.

Name

Doctoral Degree

(earned or anticipated)

  
Graduation Date  
Area of Doctoral Emphasis  
Degree-Granting Institution  
Publications:  
     # of first-author  
     # of co-author  
Conference Presentations:  
     #  of first author  
     # of co-author  
Teaching experience (y/n)?  
     If yes, what classes?  
Research Interests

(list topic areas)

  

 
Recommendation Letters From:
1.
2.
3.
4.

Gender  (circle one):             

                                                               Male                             Female

 

Ethnic Category (circle one):

 

                                                    Hispanic or Latino              Non Hispanic or Latino        

 

Race (circle one):

 

American Indian/       Asian         Native Hawaiian             Black or                White         More than

Alaska Native                                      or Other             African American                           one race

                                    Pacific Islander                                                                        

                                                                                                                                                                                                                                  

This form with should be included with other application materials and sent to: 

         Karen A. Matthews, Ph.D.

         Department of Psychiatry

         University of Pittsburgh

         3811 O'Hara Street

         Pittsburgh, PA  15213

Training Faculty Research Interests                                    How To Apply

 

 

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