2018 Breitman-Dorn Fellowship Requirements and Application Form
Step 1: Review
Step 2: Fill out form below and upload all required supporting materials.
Application Deadline: August 24, 2018
Full Name of Applicant
Applicant Street Address
Address Line 2
Daytime Phone Number
Anticipated Graduation Date:
Title of Dissertation:
Graduate Program Reference
Please download the Graduate Program Reference Form via the link below and have it completed/signed by your principal dissertation advisor. Then upload it in the field below.
View and print Graduate Program Reference Form.
Upload signed Graduate Program Reference Form.
For the Applicant:
I attest that the contents of this fellowship application are true and accurate. I agree that if I receive the fellowship, my photograph and information about my dissertation topic may be published in AAPA and PA Foundation publications. I also agree to provide the PA Foundation with a copy of my completed dissertation.
Additional Documents Required
Attach a one-page letter from the chair of the dissertation committee stating that you are approved to go forward with research for the dissertation. The letter should include a description of the current status of the research project.
Attach your current headshot.
Attach current unofficial graduate academic transcript.
Attach abstract(s) of recent and relevant publication(s) that you have authored or co-authored (three maximum).
Attach current résumé/curriculum vitae.
Provide a description of the proposed research that includes the following: introduction, purpose and significance, literature review, research design and plan for evaluation of results (not to exceed 1,000 words). If you are a re-applicant for this fellowship, describe what is different in this proposal and/or how you have progressed in your research since your previous application.
Explain your personal commitment to research on or about the PA profession and outline your career plans for the next five years (not to exceed 500 words).