Thank you for your interest in the Scaife Advanced Medical Student Fellowship in Substance Use Disorders. Please complete the information requested on this application form.

* 1. Please complete the following school information.

* 2. Your contact information

* 3. Gender

* 4. Session Preference

* 5. How many years of study have you completed in medical school?

* 6. How many years of clinical work have you completed in medical school?

* 7. Do you need school credit for this fellowship? (*Check Yes if you would like to take this fellowship for credit. Students are responsible for contacting their medical school to obtain the necessary forms and instructions for receiving credit. Students are also responsible for alerting IRETA as to the necessary information required from the organization).

* 8. How much clinical or research experience have you had in the area of substance use disorders?

IMPORTANT - The answers to the following three essay questions will be scored to determine your acceptance into this program. Please answer the questions fully and clearly.

* 9. Please explain your clinical or research experience in the area of substance use disorders.

* 10. Why are you interested in participating in the Fellowship?

* 11. How will your participation help you achieve your career and personal goals?

* 12. Where did you hear about the Scaife program?

Thank you for applying.

Deadline for submission is February 28, 2018.
Only completed applications will be considered.

Questions? Contact Jessica Samuel at or call at 412-258-8569.