2018 HIVMA Medical Students Program Application

The HIVMA Medical Students program awards grants to medical student and mentor pairs to support a longitudinal clinical learning and/or research project and mentor relationship for up to three years.

To apply please do all of the following by February 15, 2018:

Complete the application form below.
Email your CV to info@hivma.org.
Request that your mentor submit a letter of support (maximum two pages) to info@hivma.org.

Please note that mentors must be IDSA/HIVMA members in good standing.

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* 1. General Information

First Name

Middle Initials

Last Name

Email address

Institution

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* 2. Contact Information

Street Address

Address Line 2

City

State

Zip

Phone

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* 3. Program Type (e.g. MD, MD/MPH, MD/PhD)

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* 4. Year in School

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* 5. Number of Years of Funding Requested

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* 6. Anticipated Project Dates

Start Date

End Date

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* 7. Project Title

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* 8. In 500 words or less, please discuss your interest in the field of HIV focusing on your project plan if granted an HIVMA Medical Students award. Include learning goals and activities or projects that you anticipate completing with this support and how they complement your training curriculum.

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* 9. Please list any additional sources of project funding that you have or are currently applying for. (We prioritize projects that do not have funding. Projects that are fully-funded are not eligible.)

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* 10. Mentor Information

Mentor's Name

Mentor's Phone

Mentor's E-mail

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* 11. How did you learn about the HIVMA Medical Student Program?

Google or other search engine

HIVMA member

Program Director

Other (please specify)