LEAD Fellowship Application 2022-23

New Leaders in Equity & Diversity Fellowship Application

Application deadline EXTENDED: Tuesday, May 31, 2022, at 11:59 pm ET
Read the New Leaders in Equity & Diversity Fellowship overview and eligibility carefully prior to submitting your application.

SOPHE is an equal opportunity employer. Self-identification in response to these questions is entirely voluntary and in no way entitles any individual to or excludes any individual from consideration for employment by SOPHE.

Accepted fellows will be notified by June 15, 2022 (subject to change)

Note on confidentiality: The demographic information provided by applicants on SOPHE's LEAD Fellowship application will only be used for the limited purpose of evaluating candidates and selecting prospective fellows. The demographic information provided herein, as well as the accompanying application materials, will only be accessible to the limited group of reviewers who are responsible for selecting candidates for the LEAD Fellowship. SOPHE will maintain the confidentiality of all information collected in accordance with its Privacy Policy, and will retain LEAD Fellowship application records in accordance with its Document Retention Policy.

Policies are available upon request. Please email: education@sophe.org
Have you read and do you understand the instructions. *

Yes, I have read and understand the instructions.
I. Personal Data. Required information

All correspondence and award agreements are generated from the information submitted. Please check your spelling, capitalization and punctuation.
Name

First Name Last Name
Preferred Name

First Name Last Name
Job Title/Position *
Organization/College/University *
Highest level of education completed *
E-mail : *
Where the confirmation will be sent to
Birthdate: *

Month Day Year
Preferred Mailing Address : *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Preferred Phone number *
Phone Number
Phone type *
Are you a current National SOPHE member? *

Yes No Unsure
If you are not a current SOPHE member or unsure of your membership status, please check your My.SOPHE account profile. The LEAD Fellowship is restricted to current SOPHE members for the duration of the fellowship.
II. Demographics

The desired candidate for the LEAD Fellowship is a member of a group that is underrepresented in the public health and all related fields with regard to their: racial and/or ethnic background, age, gender, gender identity and expression, transgender status, sexual orientation, disability status, religion, military status, national origin, or economic status.
Do you identify as a member of a listed underrepresented group? *

Yes No
I identify as a member of this (these) underrepresented group(s)

racial and/or ethnic background age gender gender identity & expression transgender status sexual orientation disability status religion military status national origin economic status
If you are not a member of the listed underrepresented groups, of which other group are you a member? *
My race/ethnicity is (check all that apply): *

African American/Black American Indian/Native American Hispanic/Latino Asian American/Asian Native Hawaiian/Other Pacific Islander White/Caucasian Other (please specify)
Please specify *
Gender Identity *
Preferred Pronouns
Sexual Orientation (please specify below) *
Americans with Disabilities Act (ADA) defines an individual with a disability as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.

Information related to an applicant’s disability status is requested on a voluntary basis by SOPHE in connection with its LEAD Fellowship application, which is being used solely to promote diversity, equity, and inclusion with regard to disability. All information collected is kept confidential in accordance with the ADA. Refusal to provide this information will not subject the applicant to any adverse treatment, and all information collected will be used only in accordance with the ADA.
Do you identify as a person with a disability?

Yes No Self idenfication
All information collected is kept confidential in accordance with the ADA. Refusal to provide this information will not subject the applicant to any adverse treatment, and all information collected will be used only in accordance with the ADA. *
III. Supplemental materials

Prospective candidates should submit the following documents as part of their application: Please submit PDF documents.
- A personal statement of how the LEAD Fellowship will impact the applicant’s goals as a future leader within SOPHE that promotes and creates opportunities for diversity, Your statement should be approximately 400-500 words.
- CV/Resume
Personal statement *

Browse Files

Cancel of
CV/Resume *

Browse Files

Cancel of
Two (2) letters of recommendation – one from a personal friend, colleague, etc., and one from a professional colleague, supervisor, etc., should be sent to leadfellowship@sophe.org. Recommendation letters should reflect the following:
- Personal or professional relationship to the applicant.
- Applicant’s demonstrated leadership skills.
- How the LEAD fellowship will align with applicant’s professional goals/career.
- Applicant's professional/personal skills, qualities, and qualifications.
Please complete the following information for each person who is submitting a letter of recommendation.
Name

First Name Last Name
Email
example@example.com
Name

First Name Last Name
Email
example@example.com
IV. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature: *
Should be Empty:

New Leaders in Equity & Diversity Fellowship Application