Diversity Fellowship Application | American Society of Neurorehabilitation

Diversity Fellowship Application

First Name *
Last Name *
Institution *
Department *
Are you a current member of ASNR? *
Email *
Number of years you have attended the ASNR Annual Meeting *
Age *
Which underrepresented ethnic or disability group do you most closely identify with? *
Highest Degree *
Date Degree Received *

Undergraduates and Graduate students who are enrolled in a degree seeking program are eligible for the fellowship. Awardees will be selected according to their academic background, experience, and research interests.

Current Academic Institution
Advisor Name
Advisor Email
Degree Being Sought
Are you a Postdoc, resident, or student? *

Clear Selection
Brief statement of research interests *
(Maximum characters: 2000)
You have characters left.

The following documents are required for your application and must be uploaded as a single PDF file:

  • Proof of documented disability
  • Current CV
  • Two letters of recommendation
Please upload your documents as a single PDF file here *
How did you learn of this Fellowship?
(Maximum characters: 2000)
You have characters left.
If granted this award, I am willing to serve as a mentor to a first year Diversity Fellow during the third year of my Diversity Fellowship award. *

Clear Selection



Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

image widget