MMED Application Form

Note that your application is complete when we have received the following documents:

  • This electronic application form (required)
  • A current Curriculum Vitae (required)
  • An abstract of no more than 400 words describing a current or planned research project (required)
  • A statement of interest and intent indicating how the experience would enhance your short-term and long-term research goals (required; approx. 500-1000 words)
  • A letter of recommendation (required for graduate students only).
    • In addition to providing an evaluation of the candidate, the letter of
      recommendation must indicate support for continuation of the group
      research project following return to the home institution.
    • The letter of recommendation should be submitted separately by the faculty member writing the recommendation. Letters should be emailed to ici3d [at] by the application deadline.

Funding is available to cover room, board, and travel costs for a limited number of Clinic participants from the US and Africa. To be considered for travel support, you must also submit:

  • A letter requesting travel support and indicating the airport from which you would plan to depart.

The CV, abstract, statement of interest, and request for travel support (if applicable) should be combined into a single PDF and uploaded for submission with the application form.

  • The deadline for receipt of applications from individuals based at North American institutions for MMED 2016 is February 15, 2016 at 5pm Eastern.
  • The deadline for receipt of applications from individuals based at African institutions for MMED 2016 is March 1, 2016 at 5pm Eastern.

All application materials (including recommendation letters, as applicable) should be submitted by the deadline. Late or incomplete applications will not be considered.

  • Applicant Name

  • Address and Contact Information

  • Personal Data (optional)

  • *We are required to track this information because some of the funding for the ICI3D Program comes from the U.S. federal government. You are not obligated to answer these questions.
  • Completed Academic Degrees

  • Academic Degrees In Progress

  • Academic Background

  • Academic Coursework

  • What is your proficiency with the following computer programming languages or statistical software?
  • Upload

  • Please combine all required documents (Curriculum Vitae, Abstract, Statement of Interest) and your request for travel support (if applicable) into a single PDF document and upload it here