2021-2022 UC-LEND Fellowship Application

NOW CLOSED

To apply to be a long-term UC-LEND trainee, you will need to complete or submit the following:

Online UC-LEND application
Personal statement
- In 300 words or less, please describe the personal and professional qualities you use to define or describe leadership.
- In 300 words or less, please discuss how you hope the UC-LEND long term traineeship will shape or impact your graduate training.
Curriculum vita
Unofficial transcript
Two completed UC-LEND Recommendation Forms
- At least one form must be from either a faculty advisor or supervisor (UC-LEND faculty may serve as your reference)
- Completed forms must be either:
  1. EMAILED directly to Kary Calderon (kmcalderon@mednet.ucla.edu)

All individuals interested in becoming a medium– or long-term trainee must complete this application. Please complete the form below to apply for the 2021-22 UC-LEND Training cycle. *Eligibility for a stipend includes acceptance into UC-LEND as a long-term trainee, U.S. Citizen, and enrolled students at a 4-year institution.

Applications are due April 30, 2021. Deadline for applications extended to May 21, 2021.

Letters of Recommendations due date extended to June 4, 2021.

Participant Info
First Name
Middle Initial
Last Name
Applying for	Applying for Long-term Medium-term Practitioner Track
University ID	If you are applying for the practitioner track, enter “N/A”
Affiliation	Affiliation UCLA UCR N/A
Degree Program (MS, MPH, MSW, PhD, etc)
Discipline or Academic Department
Expected Graduation Term and Year (ex. Spring 2021)	If applicable
Date of Birth
Sex	Sex Female Male Other Prefer Not To Disclose other:
I am a:	I am a: U.S. Citizen Permanent Resident/Green Card Holder
Race	Race White or Caucasian Hispanic or Latino or Spanish Origin Black or African-American Asian Native American or Alaska Native Middle Eastern or North African Native Hawaiian or Other Pacific Islander Prefer not to respond other: Response optional and for demographic tracking/reporting purposes only (please select “Prefer Not To Respond” if you do not wish to provide this information). Please select all that apply.
Non-University Email
Phone	Please enter phone number in following format: 310-555-5555
Address
City
State
Zip Code
Primary Language
Additional Languages
CV	Please upload your CV in PDF (preferred) or Microsoft Word format. NOTE: Please use the following convention to name your file: LastName, FirstName.CV.pdf or LastName, FirstName.CV.doc
Personal Statement	Please upload your Personal Statement in PDF (preferred) or Microsoft Word format. Please make sure that you address the two writing prompts and designate them as separate sections of your statement: 1) In 300 words or less, please describe the personal and professional qualities you use to define or describe leadership; and 2) In 300 words or less, please discuss how you hope the UC-LEND long term traineeship will shape or impact your graduate training. NOTE: Please use the following convention to name your file: LastName, FirstName.Statement.pdf or LastName, FirstName.Statement.doc
Only for Long-Term Trainee Applicants: Unofficial Transcript	Please upload your unofficial transcript in PDF format. NOTE: Please use the following convention to name your file: LastName, FirstName.Transcript.pdf or LastName, FirstName.Transcript.doc
Only for Long-Term Trainee Applicants: Recommendation Forms	I understand that my application will be incomplete and will not be reviewed until the UC-LEND coordinator receives two (2) recommendation forms (either via direct email from your references to admin@uc-lend.org or via delivery to 10960 Wilshire Blvd, Suite 960, Los Angeles, CA 90024).
I am NOT a robot.	8 × 5 = ? Please solve the simple math question above to prove that you are not a robot.

2021-2022 UC-LEND Fellowship Application

NOW CLOSED

Applications are due April 30, 2021. Deadline for applications extended to May 21, 2021.

Participant Info