0920-23DP PHL Fellow Application

Form approved

OMB No. 0920-XXXX

Expiration date: XX/XX/XXXX

Public Health Law Fellowship Application

To apply as a fellow in the Public Health Law Fellowship, please complete the survey below.

To complete this survey, please select the answer that applies to each question posed below. If it is possible to choose more than one answer, the question will have an instruction to select all that apply.

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There is no time limit to complete the survey. All questions will be displayed on one page. You will see two options at the bottom of the page, “Save & Return Later” and “Submit,” indicating the end of the survey.

Before submitting your survey, you may save your progress and return later to complete the survey by selecting the “Save & Return Later” option at the bottom of the page. If you select “Save & Return Later,” you will be given a return code when leaving a survey. The return code is required to re-enter and finish the survey. We are not able to retrieve lost codes, so if you cannot find your code, you will need to restart the survey. Selecting “Save & Return Later” does not submit your answers.

To submit your answers, you must select “Submit.” Your survey responses will be submitted, and you will see a survey completion note thanking you for your submission. You will not be able to edit your responses once your survey is submitted. You will be able to download a PDF of your application responses if you would like to.

Thank you!

Public reporting burden of this collection of information is estimated to average 7 minutes per response, including the time for reviewing the instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Information Collection Review Office, 1600 Clifton Rd. NE, MS H21-8, Atlanta, GA 30329; ATTN: PRA (0920-XXXX). 

What is your name? __________________________________

What is the best email address to contact you? __________________________________

Please select the degree(s) you are currently seeking. If you are not currently seeking a degree, please select the degree(s) you most recently completed.

• JD

• Master of public health

• Master of public administration

• Master of public policy

• PhD

• DrPH

• Other ______

Please select which of the below best describes you. (Note: To qualify for the Public Health Law Fellowship as a law student, you must complete your 2L year by the start of the fellowship.)

• Rising or current 3rd year student at an ABA-accredited law school

• Graduated from an ABA-accredited law school within the past 4 years

• Neither

Please select which best describes you

• Current graduate student in a master's or doctoral program

• Graduated from a master's or doctoral program within the past 4 years

• Neither

Thank you for your interest in the Public Health Law Fellowship and Intern/Extern program. Based on your responses, you are not currently eligible for these programs. To be eligible for the Intern/Extern program, you must be a current law, master’s, or PhD student. Law students must have completed their 2L year by the start of the inter/externship. To be eligible for the fellowship program, you must be a current law, master’s, or PhD student, or have graduated from one of these programs within the past 4 years. Current law students must have completed their 2L year by the start of the fellowship. We encourage you to apply for one of these positions should you become eligible in the future. If you wish to correct the information above, please do so now. If you do not wish to correct the information above, please select "No" to end the survey now.

• Yes

• No

Based on your responses, you are eligible to apply to the fellowship program and the intern/extern program. Intern/externs will be placed at CDC in an unpaid capacity but may be eligible to receive course credit.

Fellows are paid positions that may be placed at CDC or in field offices.

Please select the program for which you would like to apply.

• Public Health Law Fellowship

• CDC Internships & Externships in Public Health Law

Which internship are you applying for?

• Administrative and Communications

• Public Health Law

Current academic institution, or academic institution you graduated from within the past 4 years, if not currently in school. _______________________________________

If you are a current student, please enter your anticipated graduation date. _______________________

If you have already graduated, please enter the date you graduated with your most recent degree. ____________

• Please upload a copy of your resume

Why are you interested in working as a public health law fellow or intern and how does it fit with your previous experience? (200-word limit) __________________________________

Which of the public health topics interest you the most? (Select all that apply)

• Vaccination

• Health equity

• Emergency preparedness

• Environmental health

• Maternal and child health

• Coroner/medical examiner laws

• Public health data systems

• General legal counsel/clerkship

• Other ______

What is your highest degree of education completed?

• High school/GED

• Associate's degree

• Bachelor's degree

• Master's degree

• Professional degree (MD, JD)

• Doctoral degree

• Other, please specify ______

For each degree attained, please enter the major/concentration, academic institution, and date of graduation below __________________________________

Do you identify as having any kind of disability?

• Yes

• No

• Prefer not to respond

How would you describe your race? Select all that apply.

• White

• Black or African American

• Asian

• American Indian or Alaska Native

• Native Hawaiian or other Pacific Islander

• Other (please specify) ______

• Prefer not to respond

How would you describe your gender identity? Gender identity can be defined as "one's innermost concept of self as male, female, a blend of both, or neither-how individuals perceive themselves and what they call themselves. One's gender identity can be the same or different from their sex assigned at birth." __________________________________

Do you consider yourself Hispanic or Latino?

• Yes

• No

• Prefer not to respond

Please select the option below that best describes you

• US citizen

• Legal permanent resident of the United States

• Neither

Which fellowship experience would you prefer?

• Field placement in a state or local health department

• Placement in a CDC center

Please enter your current city, state, and zip code. If you expect to be located somewhere else at the time of the fellowship or intern/externship, please enter your anticipated city, state, and zip code instead.

City: _______________________

State: ____________________________

Zip: __________________________

Please select your preference.

• In-person fellowship or intern/externship

• Remote fellowship or intern/externship

• Hybrid fellowship or intern/externship

• No preference

Are you willing to relocate for a fellowship or intern/extern opportunity? Please note, we have many remote opportunities, so answering "no" to this question does not disqualify you from consideration.

• Yes

• No

Please rank the cohorts you would like to participate in:

First choice: _____________________________

Second choice: ________________________________

Third choice: ________________________________

Answer choices are:

• Spring

• Summer

• Fall

Answer choices are:

• 40 hours/week (full time)

• 30–39 hours/week

• 20–29 hours/week

• 10–19 hours/week

• Fewer than 10 hours/week