Fellows Application Form

KEYSTONE SYMPOSIA FELLOWS PROGRAM
APPLICATION

The application form and all required supporting documents must be received no later than October 21, 2024.

Preference will be given to candidates whose research interests align with scientific areas represented at Keystone Symposia's conferences. Applicants may be contacted for follow-up interviews and will be notified of final decisions by mid-November. For additional details on this program, please follow this link.

PLEASE NOTE: All progress on this application will be saved for 24 hours from the access time. Post 24 hours your field values will be lost.

PLEASE PROVIDE THE FOLLOWING:

1. Updated Curriculum Vitae

2. Two professional references, who can speak to:
- The ways in which this fellowship opportunity could potentially benefit/advance your career.
- Your potential for leadership in the scientific community
- Your commitment to mentorship and career development of trainees
We will contact your references to request a reference letter.

3. Information in the form below
PERSONAL INFORMATION
Applicant Name*

First NameMiddle Name/InitialLast Name
Preferred Name
Nickname
Email*
example@example.com
Please indicate the fellowship opportunity you are applying to (eligibility criteria: https://www.keystonesymposia.org/diversity/fellows-program):*

Postdoc Fellows ProgramEarly-stage investigators (ESI) Fellows Program
Degree (check all that apply):*

PhDMDDVMOther
Field of Study*
Citizenship *
Gender*
Please indicate which of the following best represents your racial or ethnic heritage (check all that apply):*

Black/African AmericanHispanic/LatinxNative American/Alaska NativeNative Hawaiian/Pacific IslanderNon-Hispanic WhiteAsianPrefer not to RespondOther
Are you an individual with a disability?*
(More info at: https://adata.org/faq/what-definition-disability-under-ada)
Are you from a disadvantaged or underserved background?*
(More info at: https://extramural-diversity.nih.gov/diversity-matters/disadvantaged-backgrounds)
I was or currently am (check all that apply):

Homeless;In the foster care system;Eligible for Federal food assistance programs for two or more years;A first-generation college graduate;Eligible for Federal Pell grants;Raised in a designated U.S. rural area or Low-Income/Health Professional Shortage Area.None of the abovePrefer not to respond
Please describe your eligibility for this program. *
How did you learn about the Fellows Program?*
CURRENT EMPLOYER
Name of Organization*
Your Position Title*
Start Date*
mm/dd/yyyy
Employment Address*

Street Address/Department

Street Address Line 2

CityState

Zip Code
PROFESSIONAL REFERENCES

Please provide the names of two professional references that our staff may contact to request recommendations.
Professional Reference #1 - Name*

First NameLast NameSuffix
Reference Email #1*
example@example.com
Professional Reference #2 - Name*

First NameLast NameSuffix
Reference Email #2*
example@example.com
PLEASE ANSWER THE FOLLOWING:
1. Why are you interested in the Fellows Program? What do you hope to gain from this Program?*

Max 2,000 characters0/2000
2. What concerns do you have that might affect your career success?

Max 2,000 characters0/2000

3. Please rate the following on a scale of 1 to 5, with 5 being the highest, how you feel about your level of: *

	Rating
Confidence
Interpersonal skills
Support system
Willingness to take constructive advice
Scientific knowledge
Career path options

4. Please rate the following on a scale of 1-5, with 5 being the highest areas that you would particularly seek mentorship:*

	Rating
Grant writing
Publication strategy
Running a lab, assigning projects, and hiring
Scientific presentations and communications
Navigating the workplace environment
Work/life balance
Tenure Strategy
Long-term career planning
Biotechnology startups
Clinical and/or regulatory career paths
Collaborating and/or careers in pharma or biotech companies

5. Is there any other information that you would like to share with us?

Max 2,000 characters0/2000
Supporting Documents
Upload Current Curriculum Vitae*

Browse Files

Cancelof
TERMS OF PARTICIPATION

To obtain a certificate of completion, this program requires the following participation. Travel award support to attend a Keystone Symposia conference is contingent upon participation outlined below:
- Onsite participation in Colorado at the Keystone Symposia Scientific Advisory Board (SAB) meetings held January 24-25, 2025, and January 23-24, 2026. Keystone Symposia will cover lodging; we offer a subsidy to defray costs for airfare, ground transportation, and per diem for the dates and location of the SAB meetings, receipts are required for all reimbursements.
- Virtual participation in the Keystone Symposia SAB meeting, tentatively scheduled for June 6-7, 2025.
- Virtual participation in at least 7 of 10 "Fellows Friday" career development sessions during your Program experience, including the SAB orientation.
- Commitment to regular communication with Keystone Symposia staff, and paired cohort mentors.
- Commitment to participate in long-term surveys regarding career advancement, as well as engaged membership in the Fellows Community Network.
By submitting this application, I understand and agree to participate in all required program activities. I also verify that the contents of my application are accurate.

Clear
Should be Empty:

KEYSTONE SYMPOSIA FELLOWS PROGRAM

APPLICATION

PLEASE PROVIDE THE FOLLOWING:

PERSONAL INFORMATION

CURRENT EMPLOYER

PROFESSIONAL REFERENCES

PLEASE ANSWER THE FOLLOWING:

Supporting Documents

TERMS OF PARTICIPATION