Master Faculty Scholars Program Application

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Program is free-of-charge. Applications are due August 31, 2018.

Please address specific content inquiries to Dr. Beverly Lunsford at bklunsfo@gwu.edu. You will be required to submit the following information:

-- Statement of Interest, maximum two pages, explaining: (1) Your current professional activities and accomplishments in relation to geriatrics, gerontology and palliative care; (2) your learning goals for enhancing your educational and culture change skills in gerontology, geriatrics and palliative care

-- Curriculum Vitae

-- Signed form from current supervisor or mentor, stating that your employer will make schedule arrangements so that you may attend program activities, if applicable.

Email *

First Name *

Last Name *

Preferred Telephone Number *

Mobile, Home or Work

Preferred Mailing Address Type *

Home

Work

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Professional Information

Profession *

Advanced Practice Nurse or PA

Social Worker

Physical Therapist

Art Therapist

Other:

For physicians and nurses, Primary Board Certification:

What is your most advanced degree? *

Elementary/secondary school

Associates Degree (e.g. AA, AAS)

Diploma (e.g. RN)

Baccalaureate Degree

Master’s Degree

Doctorate

Other:

Required

Year of last completion of training: *

(e.g. completion of last fellowship, graduation with Masters degree, etc)

Job Title and Current Position: *

Department: *

Institution: *

Academic Rank

If applicable.

Demographic Information

Optional. Information related to ethnicity, age, and gender is optional. Such data will be used only in statistical summaries and in no way will affect your selection for this program.

Gender

Female

Male

Clear selection

Age Range

Under 25

25-29

30-39

40-49

50-59

60+

Clear selection

Ethnicity

African American

Asian

Caucasian

Native American

Other:

Hispanic/Latino

Yes

Clear selection

Statement of Commitment to Participate

This is a full year commitment. This is an intensive year long program to enhance professionals’ skills in teaching geriatrics and gerontology in their work setting. Scholars are expected to develop a 160 hour learning plan that includes:

-- 40 hours classroom time (Monthly sessions at the Washington DC Veterans Affairs Medical Center). Participants are expected to attend all sessions IN THEIR ENTIRETY);
-- Teaching time in own setting;
-- Participation in a scholarly project of scholar’s choice; and
-- Participation in humanities and arts in gerontology.

In order to successfully complete the program, it is important that scholars have the support of their employer. The Center asks employers to support their scholar’s professional development by:

-- Providing scheduling leniency to permit scholars to attend 10 monthly classroom sessions
-- Support scholar in selecting and implementing a scholarly project useful to the work setting (such as a performance improvement project). This is usually a project integral to the scholar’s work responsibilities.

Check appropriate box to indicate your commitment: *

I have discussed and received the support of my employer. I commit to participating fully in all program activities. (Email to sonsas@gwu.edu: signed Employer Statement of Support if employer permission needed in order to participate.)

I cannot make this commitment at this time.

Electronic Signature *

Today's Date: *

A copy of your responses will be emailed to the address you provided.

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