Albert Schweitzer Fellows Application 1Contact & School Information2Project Information3Personal & Professional Information4Resume LinkedInThis field is for validation purposes and should be left unchanged.Name First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Preferred Email* What year of your degree program will you been during the 2025-26 academic year?* Yes No Will you be enrolled in a degree-granting program through April 2026? When is your graduation date? (December 2025 graduation is allowed if the academic mentor agrees to support the Fellow post-graduation and through project completion.)*Your School*Discipline*Degree Program*Consider all of your academic and/or clinical responsibilities during the Fellowship year. If any of these may interfere with accomplishing your Schweitzer project, please discuss.*If you anticipate being out of the area and/or unable to participate in Fellowship activities for reasons other than those listed above, indicate the date(s) and the reason(s).* What is the health disparity or inequity you propose to address? How is the disparity present in Southeast Michigan? Please include references as needed.*Please describe your proposed community service project, including the following: 1. Project goals 2. Activities to meet these goals 3. Intended outcomes of the project 4. If you are proposing to continue an existing program, please briefly describe how you might expand or build upon it*Who are the clients or patients you propose to serve through your project? What demographic factors will you use to identify or recruit/involve your target population?*Please indicate the community agency (or agencies) that will serve as your project site mentor. This is a requirement for the fellowship. Indicate if your host agency and mentor are proposed or confirmed.* If you are accepted as a fellow, once your project is formed, you will be asked to evaluate your project’s impact. Knowing that your evaluation strategies may change as the project is developed, please indicate what methods you have thought about using throughout the year to evaluate your project’s effectiveness; How will you determine how well your goals were met? What will you measure to evaluate the success of your project’s process? What will you measure to determine the impact on the target population; e.g. what short and long-term outcomes do you expect to see? Refer to your local program’s application guidelines for additional information. Project Gantt Chart Please download the attached Gantt Chart and indicate on it how you would apportion your time throughout the fellowship year, including a proposed start and end date and, where appropriate. such major phases as participant recruitment, intervention delivery, and evaluation. Download Project Gantt Chart Upload Completed Project Gantt Chart*Accepted file types: word, pdf, xls, doc, docx, jpg, png, gif, Max. file size: 10 MB. What potential challenges do you envision in carrying out your Fellowship project? If your site wishes to sustain your project after your Fellowship, what would be the estimated cost of staff, materials, and other resources required? What is the estimated cost of resources required to sustain your project?* Please include anything about your personal and professional background, as well as, motivation for applying to the Schweitzer fellowship that you would like to share with the selection committee. What personal life experience or professional awareness shaped your proposed service project? How do you think this project will shape your life moving forward after the fellowship?*Consider the complex legacy of Dr. Albert Schweitzer; how do you feel your project will employ the values he established for humanitarian work? Would Dr. Schweitzer have adopted your project? Why or why not?*Reference 1 (proposed faculty mentor)*Reference 2*Reference 3*Please list someone at your proposed site who could serve as a site mentor or who has been your site contact. Include telephone number and email address. If a possible site mentor or contact has not yet been identified, please enter tbd.* Resume*Please include a pdf attachment of your resumeAccepted file types: word, pdf, xls, doc, docx, Max. file size: 10 MB.
