LEAP Program Home > LEAP Program (2024) > LEAP Program Investigator Application LEAP Investigator Track Application Application Deadline: 11-06-2024 LEAP Investigator Track Application (2024) Name* First Middle Name/Initial Last Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip E-mail Address* This field is hidden when viewing the formPlease list any major fellowships and/or research support you've received within the past 5 years:Please include Support Source, Funding Amount ($), Fellowship/Grant Title, Your Role, PI, and other pertinent information in the field below.This field is hidden when viewing the formDegree(s)If applicable, please list your degree(s) below.Current Position*Institution*Gender* Male Female Gender Queer/Gender Non-Conforming Different Identity (please specify) Prefer not to answer Please specify*Race/Ethnicity (please select all that apply) American Indian/Alaska Native Asian Black/African American Hispanic/Latino(a) Native Hawaiian/Other Pacific Islander White Other (please specify) Please specify*I was the first person in my immediate family to graduate from a four-year college.*TrueFalseWe are interested in your life experiences that will contribute to your contributions as a LEAP participant to JCOIN’s mission. As such, please complete these questions.a. Please describe any leadership roles, life experience, community service or experience with diverse populations that have enhanced your leadership and resilience. (200 words)*b. Please describe your skills and attributes, personal qualities and relevant demographic factors that contribute to your candidacy. (200 words)*c. Please describe cultural background, important historical, political and world events that influence your career interest to improve outcomes of justice-involved populations. (200 words)*Upload your proposal*Please complete a three-page proposal for the conduct of a project to be completed over the course of the one-year program. Page limit does not include personal statement, biosketches or letters of recommendations. Please include the following: • Issue to be studied • Significance • Specific Aims • Project Activities and Approach (Methods) • References Please upload in .txt, .doc, .docx, or .pdf format below. Max. file size: 20 MB.Upload your biosketch*Please include your biosketch in .txt, .doc, .docx, or .pdf format. Max. file size: 20 MB.Upload your Letter of Recommendation*Please include a Letter of Recommendation from someone who is familiar with your work and career path in txt, .doc, .docx, or .pdf format. Max. file size: 20 MB.Upload your Personal Statement*Please include a one-page personal statement articulating your research interests in criminal justice health research and goals for participating in this program. Please upload in .txt, .doc, .docx, or .pdf format. Max. file size: 20 MB.Upload your photoPlease upload your headshot photograph (optional). The file should be .jpg, .gif, or .png format and at least 450px. This will not be part of the review process and is not required. This is requested so we may publish scholarship recipients on signage at the conference.Max. file size: 20 MB.CAPTCHA Δ
