Implementation Science Training Program Application

Full Name and Credentials(Required)

Email Address(Required)

Cell Phone(Required)

Institution Name(Required)

Institution City and State(Required)

Professional Position at the Institution Named Above(Required)

Headshot Upload(Required)

Please name your headshot in the following format: LASTNAME_FIRSTNAME

Accepted file types: jpg, png, jpeg, Max. file size: 50 MB.

CV Upload(Required)

Accepted file types: doc, docx, pdf, Max. file size: 50 MB.

Letter of support from supervisor, department chair, division chief or equivalent(Required)

Accepted file types: doc, docx, pdf, Max. file size: 50 MB.

Personal statement (maximum 3 pages) addressing the following items:

describe your interest in being selected for this program
describe your education and experience within the field, noting specific experiences working with people living with FH or policy affecting access to FH screening or medication
describe a strategy for improving detection or management of adults or children with heterozygous or homozygous FH that you would like to implement in your environment (local institution, clinic, community, etc.) – reference the IAS FH implementation science paper

Personal Statement Upload – Maximum 3 pages(Required)

Accepted file types: doc, docx, pdf, Max. file size: 50 MB.