{"id":4559,"date":"2013-11-01T16:19:02","date_gmt":"2013-11-01T20:19:02","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/care\/?page_id=4559"},"modified":"2019-06-25T14:01:48","modified_gmt":"2019-06-25T18:01:48","slug":"2020-fit-program-fellow-application","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/care\/fellow-immersion-training-fit-program\/4477-2\/2020-fit-program-fellow-application\/","title":{"rendered":"Fellow Application"},"content":{"rendered":"<div style=\"text-align: left;\"><b>Application materials will be accepted through January 24, 2020.\u00a0After you submit your application, a confirmation email will automatically be sent to your institutional email (check your spam folder.)\u00a0<span style=\"color: #b40404;\">If you do not receive a confirmation email, that means your application was NOT submitted and we did not receive it.<\/span> Please ensure all required fields are filled out and resubmit your application.<\/b><\/div>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_44' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">9th Annual Fellow Immersion Training (FIT) Program: Fellow Application<\/h3>\n                            <p class='gform_description'>To complete the application process, we require: \r\n<p><b>1)<\/b> A CV.\r\n<p><b>2)<\/b> A personal statement of no more than 300 words describing your motivation and goals for participation in the FIT Program. Relate your interest in addiction medicine and research to your previous training, Fellowship plans, your career aspirations, and how you will apply the knowledge gained at the FIT Program.\r\n<p><b>3)<\/b> A description of no more than 300 words describing a research project idea that incorporates addiction medicine and that you could undertake during your fellowship.  This description should include the project idea\u2019s aims, research question, methods and potential implications.\r\n<p><b>4)<\/b> A letter of nomination from your fellowship program director, detailing the percentage of time in your fellowship that is dedicated to research.\r\n<p><b>5)<\/b> A letter of support from a faculty mentor who will assist you in incorporating addiction issues into your clinical research. <i>Note: if your fellowship program director is also your mentor, only one letter is required.<\/i>\r\n\r\n<p><\/P ALIGN=Left>If you have any questions about your application or the FIT Program, please contact Project Manager Ve Truong at Ve.Truong@bmc.org.\r\n\r\n<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_44'  action='\/care\/wp-json\/wp\/v2\/pages\/4559' data-formid='44' >\n                        <div class='gform-body gform_body'><ul id='gform_fields_44' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_44_1\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_1\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_44_1'>\n                            \n                            <span id='input_44_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_44_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_44_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_44_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_44_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_44_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_44_2\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_2\"><label class='gfield_label gform-field-label' for='input_44_2' >Preferred first name\/nickname (as you would like it on your badge should you be accepted to the program):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_44_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_37\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_37\"><label class='gfield_label gform-field-label' for='input_44_37' >Degree(s) earned (e.g., MD, MPH):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_44_37' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_7\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_7\"><label class='gfield_label gform-field-label' for='input_44_7' >Institutional\/work email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_44_7' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_44_34\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_34\"><label class='gfield_label gform-field-label' for='input_44_34' >Personal email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_44_34' type='text' value='' class='medium'  aria-describedby=\"gfield_description_44_34\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_44_34'>Please include an additional (e.g., non-institutional) email address you may be reached at<\/div><\/li><li id=\"field_44_49\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_49\"><label class='gfield_label gform-field-label' for='input_44_49' >Preferred email for FIT communications:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_49' id='input_44_49' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Institutional email' >Institutional email<\/option><option value='Personal email' >Personal email<\/option><\/select><\/div><\/li><li id=\"field_44_8\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_8\"><label class='gfield_label gform-field-label' for='input_44_8' >Institutional\/work phone:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_44_8' type='text' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_44_9\"  class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_9\"><label class='gfield_label gform-field-label' for='input_44_9' >Personal phone:<\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_44_9' type='text' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_44_56\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_56\"><label class='gfield_label gform-field-label' for='input_44_56' >Preferred phone for FIT communications:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_56' id='input_44_56' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Institutional phone' >Institutional phone<\/option><option value='Personal phone' >Personal phone<\/option><\/select><\/div><\/li><li id=\"field_44_3\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_3\"><h2 class=\"gsection_title\">Fellowship Program Address<\/h2><\/li><li id=\"field_44_4\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_4\"><label class='gfield_label gform-field-label' for='input_44_4' >Institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_44_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_5\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_5\"><label class='gfield_label gform-field-label' for='input_44_5' >Specialty (e.g., infectious disease, pain):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_44_5' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_6\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_6\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Fellowship program address:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_44_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_44_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_44_6_1' value=''    aria-required='true'    \/>\n                                        <label for='input_44_6_1' id='input_44_6_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_44_6_2_container' >\n                                        <input type='text' name='input_6.2' id='input_44_6_2' value=''     aria-required='false'   \/>\n                                        <label for='input_44_6_2' id='input_44_6_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_44_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_44_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_44_6_3' id='input_44_6_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_44_6_4_container' >\n                                        <input type='text' name='input_6.4' id='input_44_6_4' value=''      aria-required='true'    \/>\n                                        <label for='input_44_6_4' id='input_44_6_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_44_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_44_6_5' value=''    aria-required='true'    \/>\n                                    <label for='input_44_6_5' id='input_44_6_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_44_6_6_container' >\n                                        <select name='input_6.6' id='input_44_6_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_44_6_6' id='input_44_6_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_44_21\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_21\"><label class='gfield_label gform-field-label' for='input_44_21' >Fellowship program medical school affiliation, if any:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_44_21' type='text' value='' class='medium'  aria-describedby=\"gfield_description_44_21\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_44_21'>Write N\/A if there is none.<\/div><\/li><li id=\"field_44_50\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_50\"><label class='gfield_label gform-field-label' for='input_44_50' >Fellowship program hospital affiliation, if any:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_44_50' type='text' value='' class='medium'  aria-describedby=\"gfield_description_44_50\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_44_50'>Write N\/A if there is none.<\/div><\/li><li id=\"field_44_38\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_38\"><label class='gfield_label gform-field-label' for='input_44_38' >Faculty mentor name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_44_38' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_39\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_39\"><label class='gfield_label gform-field-label' for='input_44_39' >Faculty mentor email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_44_39' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_41\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_41\"><label class='gfield_label gform-field-label'  >Is your faculty mentor the same as your fellowship program director?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_44_41'>\n\t\t\t<li class='gchoice gchoice_44_41_0'>\n\t\t\t\t<input name='input_41' type='radio' value='Yes'  id='choice_44_41_0'    \/>\n\t\t\t\t<label for='choice_44_41_0' id='label_44_41_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_41_1'>\n\t\t\t\t<input name='input_41' type='radio' value='No'  id='choice_44_41_1'    \/>\n\t\t\t\t<label for='choice_44_41_1' id='label_44_41_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_44_33\"  class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_33\"><label class='gfield_label gform-field-label' for='input_44_33' >Fellowship program director name:<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_44_33' type='text' value='' class='medium'  aria-describedby=\"gfield_description_44_33\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_44_33'>Note: if you have already provided the fellowship program director's information above, you may leave these fields blank.<\/div><\/li><li id=\"field_44_35\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_35\"><label class='gfield_label gform-field-label' for='input_44_35' >Fellowship program director email:<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_44_35' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_10\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_10\"><h2 class=\"gsection_title\">Mailing Address<\/h2><\/li><li id=\"field_44_11\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_11\"><label class='gfield_label gform-field-label'  >Same as above?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_44_11'>\n\t\t\t<li class='gchoice gchoice_44_11_0'>\n\t\t\t\t<input name='input_11' type='radio' value='Yes'  id='choice_44_11_0'    \/>\n\t\t\t\t<label for='choice_44_11_0' id='label_44_11_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_11_1'>\n\t\t\t\t<input name='input_11' type='radio' value='No'  id='choice_44_11_1'    \/>\n\t\t\t\t<label for='choice_44_11_1' id='label_44_11_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_44_12\"  class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_12\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Mailing address:<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_44_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_44_12_1_container' >\n                                        <input type='text' name='input_12.1' id='input_44_12_1' value=''    aria-required='false'    \/>\n                                        <label for='input_44_12_1' id='input_44_12_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_44_12_2_container' >\n                                        <input type='text' name='input_12.2' id='input_44_12_2' value=''     aria-required='false'   \/>\n                                        <label for='input_44_12_2' id='input_44_12_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_44_12_3_container' >\n                                    <input type='text' name='input_12.3' id='input_44_12_3' value=''    aria-required='false'    \/>\n                                    <label for='input_44_12_3' id='input_44_12_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_44_12_4_container' >\n                                        <input type='text' name='input_12.4' id='input_44_12_4' value=''      aria-required='false'    \/>\n                                        <label for='input_44_12_4' id='input_44_12_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_44_12_5_container' >\n                                    <input type='text' name='input_12.5' id='input_44_12_5' value=''    aria-required='false'    \/>\n                                    <label for='input_44_12_5' id='input_44_12_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_44_12_6_container' >\n                                        <select name='input_12.6' id='input_44_12_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_44_12_6' id='input_44_12_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_44_13\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_13\"><h2 class=\"gsection_title\">Other Information<\/h2><\/li><li id=\"field_44_15\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_15\"><label class='gfield_label gform-field-label' for='input_44_15' >Gender Identity<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_15' id='input_44_15' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Male' >Male<\/option><option value='Female' >Female<\/option><option value='Prefer to self describe' >Prefer to self describe<\/option><\/select><\/div><\/li><li id=\"field_44_51\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_51\"><label class='gfield_label gform-field-label' for='input_44_51' >If you selected &quot;Prefer to self describe,&quot; please specify:<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_44_51' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_22\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_22\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Race\/ethnicity:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_44_22'><li class='gchoice gchoice_44_22_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.1' type='checkbox'  value='Black or African American'  id='choice_44_22_1'   aria-describedby=\"gfield_description_44_22\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_44_22_1' id='label_44_22_1' class='gform-field-label gform-field-label--type-inline'>Black or African American<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_22_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.2' type='checkbox'  value='American Indian or Alaska Native'  id='choice_44_22_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_22_2' id='label_44_22_2' class='gform-field-label gform-field-label--type-inline'>American Indian or Alaska Native<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_22_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.3' type='checkbox'  value='Asian'  id='choice_44_22_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_22_3' id='label_44_22_3' class='gform-field-label gform-field-label--type-inline'>Asian<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_22_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.4' type='checkbox'  value='Hispanic or Latino'  id='choice_44_22_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_22_4' id='label_44_22_4' class='gform-field-label gform-field-label--type-inline'>Hispanic or Latino<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_22_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.5' type='checkbox'  value='Native Hawaiian or Other Pacific Islander'  id='choice_44_22_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_22_5' id='label_44_22_5' class='gform-field-label gform-field-label--type-inline'>Native Hawaiian or Other Pacific Islander<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_22_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.6' type='checkbox'  value='White'  id='choice_44_22_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_22_6' id='label_44_22_6' class='gform-field-label gform-field-label--type-inline'>White<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_22_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.7' type='checkbox'  value='Other'  id='choice_44_22_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_22_7' id='label_44_22_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_44_22'>Select all that apply.<\/div><\/li><li id=\"field_44_52\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_52\"><label class='gfield_label gform-field-label' for='input_44_52' >Please describe &quot;other&quot;:<\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_44_52' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_48\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_48\"><label class='gfield_label gform-field-label'  >Preferred T-shirt size (should you be accepted to the program):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_44_48'>\n\t\t\t<li class='gchoice gchoice_44_48_0'>\n\t\t\t\t<input name='input_48' type='radio' value='Women&#039;s small'  id='choice_44_48_0'    \/>\n\t\t\t\t<label for='choice_44_48_0' id='label_44_48_0' class='gform-field-label gform-field-label--type-inline'>Women's small<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_48_1'>\n\t\t\t\t<input name='input_48' type='radio' value='Women&#039;s medium'  id='choice_44_48_1'    \/>\n\t\t\t\t<label for='choice_44_48_1' id='label_44_48_1' class='gform-field-label gform-field-label--type-inline'>Women's medium<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_48_2'>\n\t\t\t\t<input name='input_48' type='radio' value='Women&#039;s large'  id='choice_44_48_2'    \/>\n\t\t\t\t<label for='choice_44_48_2' id='label_44_48_2' class='gform-field-label gform-field-label--type-inline'>Women's large<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_48_3'>\n\t\t\t\t<input name='input_48' type='radio' value='Women&#039;s x-large'  id='choice_44_48_3'    \/>\n\t\t\t\t<label for='choice_44_48_3' id='label_44_48_3' class='gform-field-label gform-field-label--type-inline'>Women's x-large<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_48_4'>\n\t\t\t\t<input name='input_48' type='radio' value='Women&#039;s xx-large'  id='choice_44_48_4'    \/>\n\t\t\t\t<label for='choice_44_48_4' id='label_44_48_4' class='gform-field-label gform-field-label--type-inline'>Women's xx-large<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_48_5'>\n\t\t\t\t<input name='input_48' type='radio' value='Men&#039;s small'  id='choice_44_48_5'    \/>\n\t\t\t\t<label for='choice_44_48_5' id='label_44_48_5' class='gform-field-label gform-field-label--type-inline'>Men's small<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_48_6'>\n\t\t\t\t<input name='input_48' type='radio' value='Men&#039;s medium'  id='choice_44_48_6'    \/>\n\t\t\t\t<label for='choice_44_48_6' id='label_44_48_6' class='gform-field-label gform-field-label--type-inline'>Men's medium<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_48_7'>\n\t\t\t\t<input name='input_48' type='radio' value='Men&#039;s large'  id='choice_44_48_7'    \/>\n\t\t\t\t<label for='choice_44_48_7' id='label_44_48_7' class='gform-field-label gform-field-label--type-inline'>Men's large<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_48_8'>\n\t\t\t\t<input name='input_48' type='radio' value='Men&#039;s x-large'  id='choice_44_48_8'    \/>\n\t\t\t\t<label for='choice_44_48_8' id='label_44_48_8' class='gform-field-label gform-field-label--type-inline'>Men's x-large<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_44_48_9'>\n\t\t\t\t<input name='input_48' type='radio' value='Men&#039;s xx-large'  id='choice_44_48_9'    \/>\n\t\t\t\t<label for='choice_44_48_9' id='label_44_48_9' class='gform-field-label gform-field-label--type-inline'>Men's xx-large<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_44_30\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_30\"><h2 class=\"gsection_title\">Fellowship Information<\/h2><\/li><li id=\"field_44_20\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_20\"><label class='gfield_label gform-field-label' for='input_44_20' >Fellowship program name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_44_20' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_43\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_43\"><label class='gfield_label gform-field-label' for='input_44_43' >What is the total length of your fellowship? (e.g., 2 year, 3 year, 4 year total)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_44_43' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_46\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_46\"><label class='gfield_label gform-field-label' for='input_44_46' >Which year of your fellowship will you be in as of April 2019?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_46' id='input_44_46' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Incoming fellow' >Incoming fellow<\/option><option value='First year fellow' >First year fellow<\/option><option value='Second year fellow' >Second year fellow<\/option><option value='Third year fellow' >Third year fellow<\/option><option value='Other (please specify below)' >Other (please specify below)<\/option><\/select><\/div><\/li><li id=\"field_44_47\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_47\"><label class='gfield_label gform-field-label' for='input_44_47' >Please describe &quot;other&quot;:<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_44_47' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_36\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_36\"><label class='gfield_label gform-field-label' for='input_44_36' >Percent of time available for research:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_44_36' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_44\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_44\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >What are your plans upon completion of your fellowship? (Check any or all that apply)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_44_44'><li class='gchoice gchoice_44_44_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.1' type='checkbox'  value='Clinician Educator'  id='choice_44_44_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_44_1' id='label_44_44_1' class='gform-field-label gform-field-label--type-inline'>Clinician Educator<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_44_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.2' type='checkbox'  value='Research'  id='choice_44_44_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_44_2' id='label_44_44_2' class='gform-field-label gform-field-label--type-inline'>Research<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_44_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.3' type='checkbox'  value='Full-time Clinical Practice'  id='choice_44_44_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_44_3' id='label_44_44_3' class='gform-field-label gform-field-label--type-inline'>Full-time Clinical Practice<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_44_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.4' type='checkbox'  value='Academic Medical Center Practice'  id='choice_44_44_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_44_4' id='label_44_44_4' class='gform-field-label gform-field-label--type-inline'>Academic Medical Center Practice<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_44_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.5' type='checkbox'  value='Private Practice'  id='choice_44_44_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_44_5' id='label_44_44_5' class='gform-field-label gform-field-label--type-inline'>Private Practice<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_44_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.6' type='checkbox'  value='Other'  id='choice_44_44_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_44_6' id='label_44_44_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_44_53\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_53\"><label class='gfield_label gform-field-label' for='input_44_53' >Please describe &quot;other&quot;:<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_44_53' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_26\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_26\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >How did you hear about the FIT Program?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_44_26'><li class='gchoice gchoice_44_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='Faculty at my institution'  id='choice_44_26_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_26_1' id='label_44_26_1' class='gform-field-label gform-field-label--type-inline'>Faculty at my institution<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='Brochure or postcard advertising the program'  id='choice_44_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_26_2' id='label_44_26_2' class='gform-field-label gform-field-label--type-inline'>Brochure or postcard advertising the program<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_26_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.3' type='checkbox'  value='Internet search'  id='choice_44_26_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_26_3' id='label_44_26_3' class='gform-field-label gform-field-label--type-inline'>Internet search<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_26_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.4' type='checkbox'  value='Email from FIT Program'  id='choice_44_26_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_26_4' id='label_44_26_4' class='gform-field-label gform-field-label--type-inline'>Email from FIT Program<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_44_26_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.5' type='checkbox'  value='Other (describe below)'  id='choice_44_26_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_26_5' id='label_44_26_5' class='gform-field-label gform-field-label--type-inline'>Other (describe below)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_44_27\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_27\"><label class='gfield_label gform-field-label' for='input_44_27' >Please describe &quot;other&quot;:<\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_44_27' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_44_54\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_54\"><h2 class=\"gsection_title\">Application Essays<\/h2><\/li><li id=\"field_44_31\"  class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_31\"><label class='gfield_label gform-field-label' for='input_44_31' >Please provide a personal statement of no more than 300 words describing your motivation and goals for participating in the FIT Program. Relate your interest in addiction medicine and research to your previous training, fellowship plans, your career aspirations, and how you will apply the knowledge gained at the FIT Program. Please upload your statement with NAME and DATE in the header as a PDF here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='104857600' \/><input name='input_31' id='input_44_31' type='file' class='medium' aria-describedby=\"gfield_upload_rules_44_31\" onchange='javascript:gformValidateFileSize( this, 104857600 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_44_31'>Max. file size: 100 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_44_31'><\/div><\/div><\/li><li id=\"field_44_32\"  class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_32\"><label class='gfield_label gform-field-label' for='input_44_32' >Please include a description of no more than 300 words describing a research project idea that incorporates addiction medicine and that you could undertake during your fellowship.  This description should include the project idea\u2019s aims, research question, methods and potential implications. Please upload your statement with NAME and DATE in the header as a PDF here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='104857600' \/><input name='input_32' id='input_44_32' type='file' class='medium' aria-describedby=\"gfield_upload_rules_44_32\" onchange='javascript:gformValidateFileSize( this, 104857600 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_44_32'>Max. file size: 100 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_44_32'><\/div><\/div><\/li><li id=\"field_44_55\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_55\"><h2 class=\"gsection_title\">Curriculum Vitae<\/h2><\/li><li id=\"field_44_25\"  class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_25\"><label class='gfield_label gform-field-label' for='input_44_25' >Please upload your curriculum vitae (CV) as a PDF.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='104857600' \/><input name='input_25' id='input_44_25' type='file' class='medium' aria-describedby=\"gfield_upload_rules_44_25\" onchange='javascript:gformValidateFileSize( this, 104857600 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_44_25'>Accepted file types: doc, pdf, Max. file size: 100 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_44_25'><\/div><\/div><\/li><li id=\"field_44_57\"  class=\"gfield gfield--type-section gsection bu_google_recaptcha_section field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_57\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_44_58\"  class=\"gfield gfield--type-html bu_google_recaptcha gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_44_58\"><div class=\"g-recaptcha\" data-sitekey=\"6LeGxkEjAAAAAK4nzHZn3a_6jB2ELSN935WrVBfC\"><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_44' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_44\"]){return false;}  window[\"gf_submitting_44\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_44\"]){return false;} window[\"gf_submitting_44\"]=true;  jQuery(\"#gform_44\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_44' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='44' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_44' value='WyJbXSIsImQ5Y2U2OGUxNzE1OTZlYjZkN2E4MzI4YmJhNDVlODY3Il0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_44' id='gform_target_page_number_44' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_44' id='gform_source_page_number_44' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\ngform.initializeOnLoaded( function() {gformInitSpinner( 44, 'https:\/\/www.bumc.bu.edu\/care\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_44').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_44');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_44').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_44').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_44').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_44').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_44').val();gformInitSpinner( 44, 'https:\/\/www.bumc.bu.edu\/care\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [44, current_page]);window['gf_submitting_44'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_44').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [44]);window['gf_submitting_44'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_44').text());}, 50);}else{jQuery('#gform_44').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [44, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 44, currentPage: current_page } });} );} );\n<\/script>\n\n<p><strong>Please submit all additional application materials to:<\/strong><br \/>\nVe Truong<br \/>\nProgram Manager<br \/>\n801 Massachusetts Ave,\u00a02nd Floor<br \/>\nBoston, MA 02118<br \/>\nPhone: <span class=\"baec5a81-e4d6-4674-97f3-e9220f0136c1\" style=\"white-space: nowrap;\">(617) 414-6639<\/span><br \/>\n<a href=\"mailto:Ve.Truong@bmc.org\">Ve.Truong@bmc.org<\/a><!-- end #content --><!-- end .yui-b --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Application materials will be accepted through January 24, 2020.\u00a0After you submit your application, a confirmation email will automatically be sent to your institutional email (check your spam folder.)\u00a0If you do not receive a confirmation email, that means your application was NOT submitted and we did not receive it. Please ensure all required fields are filled [&hellip;]<\/p>\n","protected":false},"author":4990,"featured_media":0,"parent":4477,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/pages\/4559"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/users\/4990"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/comments?post=4559"}],"version-history":[{"count":31,"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/pages\/4559\/revisions"}],"predecessor-version":[{"id":11508,"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/pages\/4559\/revisions\/11508"}],"up":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/pages\/4477"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/media?parent=4559"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}