T-32 Postdoctoral Fellowship in Digital Mental Health Application

for the Center for Behavioral Intervention Technologies (CBITs). If you have any issues completing this form, please email cbits@northwestern.edu.

Name Name First Last
Email
Checkboxes

Checkboxes U.S. Citizen Permanent Resident
Institution and Experience
Institution Name
Institution Address Institution Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Degree Obtained
Graduation Date Graduation Date / MM / DD YYYY
What is your timeframe to start a fellowship?
Self-Identification - Ethnicity

Do you consider yourself to be Hispanic or Latino?

Hispanic or Latino is a person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race. The term "Spanish origin," can be used in addition to "Hispanic or Latino."
Please Select One:

Please Select One: Hispanic or Latino Not Hispanic or Latino Prefer not to answer
Self-Identification - Race

American Indian or Alaska Native is a person having origins in any of the original peoples of North, Central, or South America, and who maintains tribal affiliation or community attachment.

Asian is a person 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.

Black or African American is a person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black" or African American."

Native Hawaiian or Other Pacific Islander is a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White is a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Check All That Apply

Check All That Apply American Indian Or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Prefer not to answer
Self-Identification - Economic Disadvantage

Do you come from an economically disadvantaged background, defined as having at least two of the following experiences:

1) having been or currently being homeless;

2) having been part of the foster care system;

3) having been eligible for the Federal Free and Reduced Lunch Program for more than 2 years;

4) have/had no parents or legal guardians who completed a bachelor’s degree;

5) were or are eligible for Federal Pell grants;

6) received support for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) as a parent or child; or

7) grew up in one of the following areas: a) a U.S. rural area, as designated by the Health Resources and Services Administration (HRSA) Rural Health Grants Eligibility Analyzer, or b) a Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas (qualifying zipcodes are included in the file).
Please Select One:

Please Select One: Yes No Prefer not to answer
Self-Identification - Disability

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

Autism
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
Blind or low vision
Cancer
Cardiovascular or heart disease
Celiac disease
Cerebral Palsy
Deaf or hard of hearing
Depression or anxiety
Diabetes
Epilepsy
Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
Intellectual disability
Missing limbs or partially missing limbs
Nervous system condition for example, migraine headaches, Parkinson's disease, or Multiple sclerosis (MS)
Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression
Please Select One:

Please Select One: Yes, I Have A Disability, Or Have A History/Record Of Having A Disability No, I Don't Have A Disability, Or A History/Record Of Having A Disability Prefer not to answer
Application Materials

Please upload files of the following requested materials.
Attach a CV

Attach Files
Attach a Letter of Interest

Attach Files
Attach a Statement of Research Interests and Goals

Attach Files
Attach 1-2 Reprints or Preprints of Scientific Publications

Attach Files
Attach 3 Letters of Recommendation

Attach Files

Let us know in the Comments box if your letters will be sent to cbits@northwestern.edu directly from the recommender.
Comments

T-32 Postdoctoral Fellowship in Digital Mental Health Application

T-32 Postdoctoral Fellowship in Digital Mental Health Application

Institution and Experience

Self-Identification - Ethnicity

Self-Identification - Race

Self-Identification - Economic Disadvantage

Self-Identification - Disability

Application Materials