Montefiore-einstein center for bioethics certificate program in bioethics and medical humanities



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MONTEFIORE-EINSTEIN CENTER FOR BIOETHICS

CERTIFICATE PROGRAM IN BIOETHICS AND MEDICAL HUMANITIES
APPLICATION FORM 2009-2010
Name: ______________________________________________________________________________
Date of Birth: ________________________
Home Address: ______________________________________________________________________________
______________________________________________________________________________
Telephone: ______________________________________________________________________________
Office Address: ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Telephone: _________________________ Fax: ______________________________
E-mail: ________________________________________________________
Tuition for the Certificate Program is $6,000 for the 2009-2010 year. Please indicate the source of tuition payment:

 Self-pay  Institutional Support

If receiving institutional support, contact information for responsible administrator:
Administrator Name: ________________________________________________________________________
Telephone: __________________________________ Fax: ____________________________________
Email: ___________________________________________________________________________

INSTRUCTIONS FOR A COMPLETE APPLICATION


Applications must include the application form, a biographical statement and a curriculum vitae. If your tuition will be paid by your sponsoring institution, please supply a letter or other documentation of tuition support, with contact information for the responsible administrator. You may also include optional letters of recommendation.
Biographical Statement:

In essay form, please provide a biographical statement (no more than one typed, single-spaced page) that emphasizes:



  1. how your personal and professional interests make you a desirable candidate for this program;

  2. your motivation for applying for the Certificate Program in Bioethics and Medical Humanities; and

  3. specific future personal, academic, and career objectives.



Address: All applications for the 2009-2010 year should be emailed by Friday, May 1, 2009, to:

Bioethics@montefiore.org



For any questions, please contact the Montefiore-Einstein Center for Bioethics at 718 920 4630.


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