“The Fellowship gave me the tools to create results driven, community centered endeavors that allow me to translate my values into actions that are sustainable and actually benefit the communities I work with. This framework is one I will carry with me throughout the rest of my life when thinking about how to convert my service-oriented philosophy into meaningful action.”

BEN SUCCOP
2021-22 NC Fellow

Application

  • Before completing this application form, please be sure to carefully read each of the sections on the Become a Fellow page, including the FAQs at the bottom of the page.
  • There are two versions of the application: one if you are applying alone for the Fellowship and one if you are applying with a partner. Please be sure to contact the Executive Director to determine specific eligibility requirements.
  • Be sure to look over the application carefully and familiarize yourself with the information we are requesting. You may wish to draft your response using this downloadable template before submitting your application using the form below. 
  • If you have any questions about this application, please contact the Program Director.

Standard Application

Applicant Information

Will you be enrolled in a degree-granting program through April 2028?
What year in your degree program will you be during the 2027-2028 academic year?
Fellows are expected to participate in Fellowship activities throughout the year (April 2027-April 2028). Will you have significant academic/clinical responsibility during the Fellowship year that may interfere with your ability to participate in the Fellowship?
Please indicate any times you anticipate being out of the area and/or unable to participate in Fellowship activities for reasons other than those listed above.

Project Information

Describe the specific population you wish to impact with your proposed community service project. Include:
• Demographic information about the population;
• The health disparity(ies) your project will address;
• Details of the community needs assessment you conducted.
(suggested word count: 150)
Name the agency/agencies and briefly describe your relationship to the site, if applicable.
Describe your proposed community service project, including:
• Project goals and possible activities to meet those goals;
• Validated curriculum(s) you are considering using, if applicable;
• Intended outcomes you hope to see for participants;
• If you are proposing to continue an existing program, briefly describe how you might expand or build upon it;
• Why your project is the right solution and approach to meet the needs identified in your community needs assessment.
How do you plan to center your efforts around those who will benefit most from this collaboration? How will you ensure that people with lived experience are included in developing and testing your idea? (suggested word count: 200)
What evidence do you have that your project could succeed? Examples include community-based evidence (conversations or experiences with community leaders/members), a comparable existing model, and/or research-based evidence. (suggested word count: 200)
List the resources needed for implementation, present them in a budget, and identify an income or donation source. What challenges do you anticipate in implementation? Note: Fellows may choose to use all, some, or none of the $3,000 stipend for project-related expenses; using the stipend for project related expenses is neither required nor expected. (suggested word count: 200)
Strong responses will:
• Account for all likely resource needs — materials/supplies, required training or certifications, participant incentives, staff time, volunteers, and any additional support.
• Present a clear plan for acquiring each resource, including a backup plan if a resource falls through.
Fellows design their projects with outcomes in mind. What do you hope will be different as a result of your intervention, and how will you know if you achieved that change? Your evaluation strategy may shift as the project develops. Describe which methods you will consider using throughout the year to track progress toward your goals and final outcomes. (Suggested word count: 200)
Examples: baseline and follow-up validated surveys to track behavior change; participant journals to record progress toward individual goals; other methods to gauge how well community members made and sustained healthy changes. Clinically based projects typically track disease-specific changes using biomedical data.
Of the 200 total hours, 50 are for project planning (25 per partner) and may begin immediately upon selection. The remaining 150 hours must be spent in direct, face-to-face community service (75 per partner); virtual or remote contact also counts as direct service.
Direct service hours may begin no earlier than May 1 and must be completed by May 1 of the following year.
Provide a list of how you will apportion your 150 direct service hours across the Fellowship year (suggested word count: 150)
• Include a projected date and estimated hours for each activity (concrete action steps taken to achieve your project goals).
• Include time spent understanding the community and building on the needs assessment from your application. This is a starting estimate, not a fixed plan.
• Be specific about logistics: e.g., number of sessions per workshop, length of each session, participants per session, total number of workshop series, etc.
• Clearly show how your plan meets the 150-hour direct service requirement.
Describe the avenues you will explore to sustain the project beyond your time as a Fellow. (suggested word count: 200)

Personal & Professional Information as it Relates to Fellowship Activities

Why do you believe advocacy is important? Do you believe health care providers have a moral and/or ethical imperative to engage in advocacy? Please explain why or why not. What do you believe are some ways that you, as a rising health care professional, can be an advocate? (suggested word count: 150)
What inspired you to develop this particular project idea? Why do you care about this issue, and what is your relationship with those impacted by it? (suggested word count: 200)
Tell me about an obstacle you overcame. (suggested word count: 150)
What knowledge or skills would you hope to gain during your Fellowship year? (suggested word count: 75)
Share anything about your personal and professional background, as well as your motivation for applying to the Schweitzer Fellowship, that you would like the selection committee to know. (suggested word count: 800)
• Telephone number and email address:
• Describe your relationship in one sentence:
Drag & Drop Files, Choose Files to Upload
Upload a letter of support confirming the mentor has reviewed the application and agrees to serve as a mentor if a Fellowship is awarded.
• Job title and organization.
• Telephone number and email address.
Drag & Drop Files, Choose Files to Upload
Upload a letter of support confirming the mentor has reviewed the application and agrees to serve as a mentor if a Fellowship is awarded.
Telephone number and email address:
• Describe your relationship in one sentence:
• Letter of recommendation is not required.
Drag & Drop Files, Choose Files to Upload
Please upload your resumes in PDF format.
• Perform at least 200 hours of service (100 hours for paired Fellows).
• Attend the Celebration of Service on April 3, 2027 in Raleigh and in March/April, 2028 (date to be determined).
• Attend an overnight orientation retreat April 10-11, 2027 in Davidson.
• Attend a midyear retreat in the fall in Chapel Hill and monthly virtual webinars (dates to be determined).
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Partner Application

Partner A Information

Will you be enrolled in a degree-granting program through April 2028?
What year in your degree program will you be during the 2027-2028 academic year?
Fellows are expected to participate in Fellowship activities throughout the year (April 2027-April 2028). Will you have significant academic/clinical responsibility during the Fellowship year that may interfere with your ability to participate in the Fellowship?
Please indicate any times you anticipate being out of the area and/or unable to participate in Fellowship activities for reasons other than those listed above.

Partner B Information

Will you be enrolled in a degree-granting program through April 2028?
What year in your degree program will you be during the 2027-2028 academic year?
Fellows are expected to participate in Fellowship activities throughout the year (April 2027-April 2028). Will you have significant academic/clinical responsibility during the Fellowship year that may interfere with your ability to participate in the Fellowship?
Please indicate any times you anticipate being out of the area and/or unable to participate in Fellowship activities for reasons other than those listed above.

Project Information

Describe the specific population you wish to impact with your proposed community service project. Include:
• Demographic information about the population;
• The health disparity(ies) your project will address;
• Details of the community needs assessment you conducted.
(suggested word count: 150)
Name the agency/agencies and briefly describe your relationship to the site, if applicable.
Describe your proposed community service project, including:
• Project goals and possible activities to meet those goals;
• Validated curriculum(s) you are considering using, if applicable;
• Intended outcomes you hope to see for participants;
• If you are proposing to continue an existing program, briefly describe how you might expand or build upon it;
• Why your project is the right solution and approach to meet the needs identified in your community needs assessment.
How do you plan to center your efforts around those who will benefit most from this collaboration? How will you ensure that people with lived experience are included in developing and testing your idea? (suggested word count: 200)
What evidence do you have that your project could succeed? Examples include community-based evidence (conversations or experiences with community leaders/members), a comparable existing model, and/or research-based evidence. (suggested word count: 200)
List the resources needed for implementation, present them in a budget, and identify an income or donation source. What challenges do you anticipate in implementation? Note: Fellows may choose to use all, some, or none of the $3,000 stipend for project-related expenses; using the stipend for project related expenses is neither required nor expected. (suggested word count: 200)
Strong responses will:
• Account for all likely resource needs — materials/supplies, required training or certifications, participant incentives, staff time, volunteers, and any additional support.
• Present a clear plan for acquiring each resource, including a backup plan if a resource falls through.
Fellows design their projects with outcomes in mind. What do you hope will be different as a result of your intervention, and how will you know if you achieved that change? Your evaluation strategy may shift as the project develops. Describe which methods you will consider using throughout the year to track progress toward your goals and final outcomes. (Suggested word count: 200)
Examples: baseline and follow-up validated surveys to track behavior change; participant journals to record progress toward individual goals; other methods to gauge how well community members made and sustained healthy changes. Clinically based projects typically track disease-specific changes using biomedical data.
Of the 200 total hours, 50 are for project planning (25 per partner) and may begin immediately upon selection. The remaining 150 hours must be spent in direct, face-to-face community service (75 per partner); virtual or remote contact also counts as direct service.
Direct service hours may begin no earlier than May 1 and must be completed by May 1 of the following year.
Provide a list of how you will apportion your 150 direct service hours across the Fellowship year (suggested word count: 150)
• Include a projected date and estimated hours for each activity (concrete action steps taken to achieve your project goals).
• Include time spent understanding the community and building on the needs assessment from your application. This is a starting estimate, not a fixed plan.
• Be specific about logistics: e.g., number of sessions per workshop, length of each session, participants per session, total number of workshop series, etc.
• Clearly show how your plan meets the 150-hour direct service requirement.
Describe the avenues you will explore to sustain the project beyond your time as a Fellow. (suggested word count: 200)

Partner A Personal & Professional Information as it Relates to Fellowship Activities

Why do you believe advocacy is important? Do you believe health care providers have a moral and/or ethical imperative to engage in advocacy? Please explain why or why not. What do you believe are some ways that you, as a rising health care professional, can be an advocate? (suggested word count: 150)
What inspired you to develop this particular project idea? Why do you care about this issue, and what is your relationship with those impacted by it? (suggested word count: 200)
Tell me about an obstacle you overcame. (suggested word count: 150)
What knowledge or skills would you hope to gain during your Fellowship year? (suggested word count: 75)
Please include anything about your personal and professional background as well as your motivation for applying to the Schweitzer Fellowship that you would like to share with the selection committee. (suggested word count: 800)
• Telephone number and email address.
• Describe your relationship in one sentence.
Drag & Drop Files, Choose Files to Upload
Upload a letter of support confirming the mentor has reviewed the application and agrees to serve as a mentor if a Fellowship is awarded.
• Job title and organization.
• Telephone number and email address.
Drag & Drop Files, Choose Files to Upload
Upload a letter of support confirming the mentor has reviewed the application and agrees to serve as a mentor if a Fellowship is awarded.
Telephone number and email address:
• Describe your relationship in one sentence:
• Letter of recommendation is not required.
Drag & Drop Files, Choose Files to Upload
Please upload your resumes in PDF format.
• Perform at least 200 hours of service (100 hours for paired Fellows).
• Attend the Celebration of Service on April 3, 2027 in Raleigh and in March/April, 2028 (date to be determined).
• Attend an overnight orientation retreat April 10-11, 2027 in Davidson.
• Attend a midyear retreat in the fall in Chapel Hill and monthly virtual webinars (dates to be determined).

Partner B Personal & Professional Information as it Relates to Fellowship Activities

Why do you believe advocacy is important? Do you believe health care providers have a moral and/or ethical imperative to engage in advocacy? Please explain why or why not. What do you believe are some ways that you, as a rising health care professional, can be an advocate? (suggested word count: 150)
What inspired you to develop this particular project idea? Why do you care about this issue, and what is your relationship with those impacted by it? (suggested word count: 200)
Tell me about an obstacle you overcame. (suggested word count: 150)
What knowledge or skills would you hope to gain during your Fellowship year? (suggested word count: 75)
Share anything about your personal and professional background, as well as your motivation for applying to the Schweitzer Fellowship, that you would like the selection committee to know. (suggested word count: 800)
• Telephone number and email address.
• Describe your relationship in one sentence.
• Job title and organization.
• Telephone number and email address.
Telephone number and email address:
• Describe your relationship in one sentence:
• Letter of recommendation is not required.
Drag & Drop Files, Choose Files to Upload
Please upload your resumes in PDF format.
• Perform at least 200 hours of service (100 hours for paired Fellows).
• Attend the Celebration of Service on April 3, 2027 in Raleigh and in March/April, 2028 (date to be determined).
• Attend an overnight orientation retreat April 10-11, 2027 in Davidson.
• Attend a midyear retreat in the fall in Chapel Hill and monthly virtual webinars (dates to be determined).
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