**National Library of Medicine**

**INSTRUCTIONS Associate Fellowship Program**

**PLEASE READ CAREFULLY BEFORE BEGINNING APPLICATION**

The NLM Associate Fellowship Program application consists of the five
parts listed below. All materials MUST BE TYPED. Your name and Social
Security number must appear on each page. Materials submitted are
non-returnable.

Parts: 1. Structured résumé

2\. Contact information for three references

3\. Narrative questions

4\. Official transcripts for undergraduate and graduate degrees

5\. Applicant data form (optional)

**Part 1. Structured Résumé**

See attached description of each required section. Include each section
listed and no more.

**Part 2. References**

a\. Contact THREE persons who can assess your character and abilities.
If you are a recent graduate, one should be a faculty member from the
library school you attended. The others should be selected from faculty,
employers, or other library/information professionals.

b\. On the application form, list each reference's name, title, address,
phone number, and e-mail address. Indicate for how long and in what
capacity you have known this reference.

**Part 3. Narrative Questions**

Develop a narrative statement for each question. At the top of the page
for each answer, type your name and Social Security number. Then, type
the question to which you are responding in bold type. The narrative
statements will be evaluated on content and writing skills.

**Part 4. Official Transcripts**

(ORDER IMMEDIATELY AND SPECIFY THE **FEBRUARY 15, 2002** DEADLINE)

a\. Direct colleges and universities to forward one *official
transcript* for each undergraduate and graduate degree earned or about
to be earned.

b\. One transcript is acceptable for multiple degrees earned from the
same institution.

c\. If transcripts are delayed, you should send photocopies immediately.
However, official transcripts are required to complete your application.

**SUBMIT THE APPLICATION TO:**

NLM Associate Fellowship Program

Science and Engineering Education, MS 36

Oak Ridge Institute for Science and Education

P.O. Box 117

Oak Ridge, Tennessee 37831-0117

Overnight Address: 200 Badger Avenue, Oak Ridge, Tennessee 37830

FAX Number: (865) 241-5220

**DEADLINE: February 15, 2002**

**NOTE:** Applications, including transcripts, are due to ORISE by
February 15, 2002. This includes parts of the application received from
other sources. Only typed and complete application materials will be
acknowledged by February 22, 2002. Final selection for the 2001/2002
Associate Fellowship Program will be made by May 15, 2002 Please use
overnight express mail if filing near the deadline.

**National Library of Medicine**

**APPLICATION Associate Fellowship Program**

Name

> Last First Middle

Social Security Number E-mail

Work phone Home phone

**I have requested transcripts from (list below):**

[Institution City State\_\_]{.underline}

-   I am interested in an optional second year.

Signature Date

**National Library of Medicine**

**STRUCTURED RÉSUMÉ Associate Fellowship Program**

**Instructions:** Your structured résumé must address each of the
following sections in the prescribed order, if applicable. Each heading
should be in bold type. If a heading is not applicable, you must still
list it, but indicate "N/A" below the heading.

Continuation pages must have your name and Social Security number in the
top right hand corner.

**Name**

**Address**

**Phone**

**E-mail**

**Social Security Number**

**Date of Birth**

**Educational Information** (From latest to earliest. Include years
attended, date of graduation, and major area of study. List expected
graduation date if applicable.)

**Summary of Significant Work Experience** (From latest to earliest.
Indicate type of employment, e.g., salaried, hourly, practica,
volunteer, and number of hours/week.)

**Job Title**

**Organization/Company**

**Dates**

**Number of hours per week**

**Supervisor's name and phone number**

**Primary duties and responsibilities**

**Honors and Achievements**

**Publications/Presentations**

**Professional Development** (Include CE courses, special training.)

**Professional Memberships** (Include student organizations, positions
held.)

**Foreign Language and Computer Skills**

**Courses in progress not reflected on transcripts**

**SEND TO:** NLM Associate Fellowship Program, Science and Engineering
Education, MS 36, Oak Ridge Institute for Science and Education, P.O.
Box 117, Oak Ridge, Tennessee 37831-0117

Telephone number: (865) 576-9975

Fax number: (865) 241-5220

**NATIONAL LIBRARY OF MEDICINE**

**ASSOCIATE FELLOWSHIP PROGRAM**

**REFERENCE FORM**

Please type or print clearly and return to the Oak Ridge Institute for
Science and Education (fax number below).

References due February 15, 2002.

Applicant's Name

(last, first, middle)

How long and in what capacity have you known the applicant?

Length of time I am Faculty Advisor ( ) Supervisor ( ) Other ( )

In a group of 100 other library school students or librarians of
comparable experience, how would your rate the applicant with respect to
the following [characteristics]{.underline}:

+---------------------------+-----+------+------+-------+-----+------+
|                           | Be  | Ave  | A    | O     | Su  | In   |
|                           | low | rage | bove | utsta | per | adeq |
|                           |     |      |      | nding | ior | uate |
|                           | A   |      | Ave  | (top  | (   | Opp  |
|                           | ver |      | rage | 25%)  | top | ortu |
|                           | age |      |      |       | 5%) | nity |
|                           |     |      |      |       |     | to   |
|                           |     |      |      |       |     | Obs  |
|                           |     |      |      |       |     | erve |
+---------------------------+-----+------+------+-------+-----+------+
| Motivation toward a       |     |      |      |       |     |      |
| successful, productive    |     |      |      |       |     |      |
| career                    |     |      |      |       |     |      |
+---------------------------+-----+------+------+-------+-----+------+
| Growth during total       |     |      |      |       |     |      |
| period observed           |     |      |      |       |     |      |
+---------------------------+-----+------+------+-------+-----+------+
| Fertility of imagination; |     |      |      |       |     |      |
| originality of thought    |     |      |      |       |     |      |
+---------------------------+-----+------+------+-------+-----+------+
| Emotional stability and   |     |      |      |       |     |      |
| maturity                  |     |      |      |       |     |      |
+---------------------------+-----+------+------+-------+-----+------+
| Ability to work with      |     |      |      |       |     |      |
| others                    |     |      |      |       |     |      |
+---------------------------+-----+------+------+-------+-----+------+
| Mastery of fundamental    |     |      |      |       |     |      |
| knowledge in the field    |     |      |      |       |     |      |
+---------------------------+-----+------+------+-------+-----+------+
| Flexibility               |     |      |      |       |     |      |
+---------------------------+-----+------+------+-------+-----+------+
| Ability to communicate    |     |      |      |       |     |      |
| information               |     |      |      |       |     |      |
| (written-oral)            |     |      |      |       |     |      |
+---------------------------+-----+------+------+-------+-----+------+
| Self-reliance and         |     |      |      |       |     |      |
| independence              |     |      |      |       |     |      |
+---------------------------+-----+------+------+-------+-----+------+

On another sheet, please add your descriptive comments that will assist
in providing a complete picture of the applicant's character, attitudes,
and ability/potential for research. Please comment on challenges, as
well as strong points.

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Typed or Printed Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Title \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Phone
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
E-Mail
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Return to: Barbara Dorsey

Phone: (865) 576-9975 Fax: (865)241-5220

**National Library of Medicine**

**STRUCTURED RÉSUMÉ Associate Fellowship Program**

Please develop narrative statements for the following questions. **Begin
each question on a new**

**page.** At the top right-hand corner of the page for each answer, type
your name and Social Security number. Then type the questions to which
you are responding in bold type, followed by your narrative. The
narrative statements will be evaluated on content and writing skills and
should not exceed 500 words.

1.  What do you hope to gain by participating in the NLM Associate
    Fellowship Program?

2.  If selected, what will you bring to the NLM Associate Fellowship
    program?

**Send to**: NLM Associate Fellowship Program, Science and Engineering
Education, MS 36,

Oak Ridge Institute for Science and Education, P.O. Box 117, Oak Ridge,
Tennessee 37831-0117

Telephone number: (865) 576-9975 Fax number: (865) 241-5220

![](media/image1.png){width="2.3159722222222223in"
height="0.5166666666666667in"}

### National Library of Medicine

### Associate Fellowship Program

**Applicant Data**

Applicant data is important in assessing the effectiveness of our
efforts to solicit applications from a diverse population. Your
completion and submission of this form will assist us in this regard;
however, if you decide not to do so, your choice will not affect the
decision regarding your application. We appreciate your cooperation.

**Name**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Citizenship:** USA Permanent Resident Alien (PRA)

Foreign National - Country

**If you are a U.S. citizen, please complete:**

**Race and/or Ethic Origin (check one)**

Caucasian American

African American

Hispanic American

Native American

Asian or Pacific Islander American

**Birth Date** (month, day, year)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Gender** Male Female

**Physical/mental disability** (Physical or mental impairment that
substantially limits one or more major life activities; for example,
blindness, deafness, or mobility impairment): Yes No

Return to: NLM Associate Fellowship Program

Science and Engineering Education, MS 36

Oak Ridge Institute for Science and Education

P.O. Box 117

Oak Ridge, Tennessee 37831-0117

> Phone: (865) 576-9975

Fax: 865) 241-5220

> E-mail: dorseyb@orau.gov