Training Program Application Portal | Collaborative Justice-Involved Research and Training Program on Substance Use and HIV at Brown University Health

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General Information

General Questions

Please provide your full email address.*

Please provide your full name.*

Please provide your full address.*

Please provide the best contact phone number at which you may be reached.*

Institutional Affiliation

Please provide your current institutional affiliation.*

And what is your current position or title at the aforementioned institution?*

Disability

Do you identify as an individual with a disability, defined by the Americans with Disabilities Act to include a physical or mental impairment that substantially limits one or more major life activities (see https://www.ada.gov/topics/intro-to-ada/)?

Disability*

Yes

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Background

Disadvantaged background refers to:

Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act (definition: https://nche.ed.gov/mckinney-vento/);
Were or currently are in the foster care system, as defined by the Administration for Children and Families (definition: https://www.acf.hhs.gov/cb/focus-areas/foster-care);
Were eligible for the Federal Free and Reduced Lunch Program for two or more years (definition: https://www.fns.usda.gov/school-meals/income-eligibility-guidelines);
Have or had no parents or legal guardians who completed a bachelor’s degree (see https://nces.ed.gov/pubs2018/2018009.pdf);
Were or currently are eligible for Federal Pell grants (definition: https://fsapartners.ed.gov/knowledge-center/fsa-handbook/2024-2025/vol7/ch1-student-eligibility-pell-grants);
Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child (definition: https://www.fns.usda.gov/wic/wic-eligibility-requirements);
Grew up in one of the following areas: a) a U.S. rural area, as designated by the Health Resources and Services Administration (HRSA) Rural Health Grants Eligibility Analyzer (https://data.hrsa.gov/tools/rural-health), or b) a Centers for Medicare and Medicaid Services-Designated Low-Income and Health Professional Shortage Areas (qualifying zip codes are included in the file). Only one of the two possibilities in #7 can be used as a criterion for the disadvantaged background definition.

Do you identify as an individual from a disadvantaged background based on meeting two (2) or more of the aforementioned criteria?*

Yes

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Demographics

The 2024 OMB revised minimum standards include seven ethnic or racial categories: American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Middle Eastern or North African, Native Hawaiian or Pacific Islander, and White.

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Are you Hispanic or Latino?*

Yes

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What is your ethnicity or race? Please select one or more.*

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Other

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Please specify

Curriculum Vitae

Please upload a current curriculum vitae (CV).*

Max. file size: 100 MB.

Letter of Good Standing

Please upload a letter of good standing from your institution.

Max. file size: 100 MB.

Personal Statement

Please upload a personal statement which details your experience and career goals, your research interests specific to this training program, and proposed mentors, if known.

Max. file size: 100 MB.

Recommendations

Reference #1 Full Name

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Reference #2 Full Name

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Date Submitted

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