neuroscience, magnetic resonance, functional mri, fMRI, neurosurgery, brain mapping, cognitive neuroscience, eeg, positron emission tomography, ucla, neuroimaging, pulse sequences, alzheimer's, parkinsons, perception, neurophysiology, magnetic resonance imaging, functional magnetic resonance imaging, cognition, psychology, epilepsy, PET, optical intrinsic signal, OIS, QEEG, magnetoencephalography, MEG, spectroscopy

Instructions:
The UCLA-Semel Institute NeuroImaging Training Program is an NIH-sponsored project, now in its sixth year, that seeks to bring non-traditional scientists, such as mathematicians, physicists, engineering, computer science and statistics into the fields o Neuroimaging, and to promote a better understanding of these same fields among students already committed to Neuroscience.

A key educational component is participation in the specially developed two quarter course, "Principles of Neuroimaging". Interested students can follow this link to the syllabus for the current year's class. If you do not yet have the required background for the course, please note in your statement how you plan to fill in any gaps.

The fellowships are competitive. Prospective fellows should apply using this form. Felowship awards are NOT required to take the "Principles of Neuroimaging", nor are they required to obtain the complete training offered in the program.

APPLICATIONS WILL CLOSE on MAY 15, 2012

NOTE: Please be very careful in entering names and emails. Reference requests will be sent automatically; we have no means to detect typing errors.

SUGGESTION: To avoid loss of content, please convert your text to ASCII before pasting

First Name *	Last Name *
Your email address * A valid email is required
Education and Training * Please list dates and institutions for all degrees and training
Accomplishments * Please list any major accomplishments, including awards, grants, fellowships, and other forms of professional or academic recognition. If you have received federal funding (such as an NRSA or NSF fellowship), please state the agency, title, and dates of the award.
Publications If you have publications, please list them here including full reference and/or PMID. Note: In prior years most of the accepted students had one or more publications. Please end each entry with a semicolon (:)
First author publications (#) How many papers have you published as first author?        Co-author publications (#) How many papers have you published as a co-author?         Abstracts (#) How many abstracts have your authored or co-authored?
Personal statement * Provide a short statement that outlines your area of research interest and what role fMRI plays in your research. In addition, discuss how you think this course will help advance your career goals, and what particular qualities you could bring to the course as a participant . Please enter a short statement telling us why you are seeking this fellowship, and why you feel that it is particularly relevant to you and to your work.
Math and Statistics Experience * Please describe your experience with math and statistics, including any courses you have taken
You may submit up to three references, but no more than onemay be from your current research laboratory. References will be contacted automatically based on the email that you enter. Type carefully.
Reference # 1 * Please enter the names and email addresses of two references. They will be automatically contacted to request a letter of recommendation	Reference # 1 email * Please enter the names and email addresses of two references. They will be automatically contacted to request a letter of recommendation
Reference # 2  Please enter the names and email addresses of two references. They will be automatically contacted to request a letter of recommendation	Reference # 2 email  Please enter the names and email addresses of two references. They will be automatically contacted to request a letter of recommendation
Reference # 3  Please enter the names and email addresses of two references. They will be automatically contacted to request a letter of recommendation	Reference # 3 email  Please enter the names and email addresses of two references. They will be automatically contacted to request a letter of recommendation
Personal research web site If you maintain your own research web site, let us know