2007 NJCFSA Medical Student Scholarship Application

New Jersey Chronic Fatigue Syndrome Association
2010 Medical Student Scholarship Program

Download this application in Microsoft Word format here or in PDF format here.

Dear Scholarship Applicant:

Thank you for applying for the Medical Student Chronic Fatigue Syndrome Scholarship offered by the New Jersey Chronic Fatigue Syndrome Association, Inc. (NJCFSA) and administered through the Foundation of the University of Medicine and Dentistry of New Jersey.

The purpose of this scholarship is to encourage you to learn about Chronic Fatigue Syndrome (CFS) by writing an essay about this illness during the summer between your first and second years of medical school. CFS is also known as Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) and ME/CFS.

The NJCFSA Medical Student CFS Scholarship is not a financial need scholarship. Applicants will be judged solely on the quality of the essay submitted with their application.

The NJCFSA Medical Student CFS Scholarship is open to all students who have completed their first year of medical school within the State of New Jersey, are enrolled for their second year of medical school within the State of New Jersey, and are in good academic standing.

The winner of the scholarship shall receive a $3,000 award that will be applied toward the tuition of his/her second year of medical education.

Completed applications must be postmarked or electronically submitted no later than August 31^st, 2010.

If you need an additional copy of this application or any portion of it, you may download the application from the New Jersey Chronic Fatigue Syndrome’s website: http://www.njcfsa.org/medschol.html.

We would also appreciate the opportunity to learn about you, and your goals as specified in the application.

We hope that the process of writing the essay for this scholarship, and possibly being the winner of it, will contribute to your becoming a physician who is better able to assist and provide compassionate care for patients suffering from CFS and similar, complex illnesses with no known cures.

NJCFSA, Inc. is a registered 501(c)(3) non-profit charitable organization dedicated to supporting CFS patients and their families, and promoting education and research into the causes and cure of Chronic Fatigue Syndrome (ME/CFS).

If you have any questions regarding your CFS Medical Student Scholarship application, please contact Ramona Ponce-Larsen of the Foundation of UMDNJ at 908-731-6592.

If you have questions about CFS, the NJCFSA, or need assistance in obtaining source material for your essay, please contact Dr. Kenneth J. Friedman, Chair, Medical Student Scholarship Committee, NJCFSA, P.O. Box 477, Florham Park, NJ 07932, or via email at: kenneth.j.friedman@gmail.com

Sincerely,

Kenneth J. Friedman, Ph.D.

Chair, Medical Student Scholarship Committee

New Jersey Chronic Fatigue Syndrome Association, Inc.

New Jersey Chronic Fatigue Syndrome Association

2010 Medical Student Scholarship Program

Application/Applicant Requirements

Please read the application/applicant requirements below carefully. Applicants must:

Be a medical student who has successfully completed his/her first year of medical school in one of UMDNJ’s three medical schools, be enrolled for his/her second year, and be in good academic standing.
Complete the application in every detail. Incomplete applications will automatically disqualify applicants.
Research and write an essay on the stated topic concerning Chronic Fatigue Syndrome. The essay must be written by the applicant after the Spring, 2010 semester of medical school. The work must be the applicant’s and represent original work.
Not have offered or submitted the essay elsewhere.
Agree that the submitted essay becomes the property of the NJCFSA, and that the essay may be used by NJCFSA for advertisement purposes, and/or published in any of the Association’s publications.
Provide a one-page, Biographical/Personal Statement as part of the application. Include any information that you would like the Scholarship Committee to consider when reviewing your application.
Provide the name and address of your local newspaper.
Attach an official transcript from the registrar’s office of your medical school or arrange to have a transcript sent to Ramona Ponce-Larsen at the Foundation of UMDNJ.

Submit the application by August 31^st, 2010 to:

Ramona Ponce-Larsen,

Foundation of UMDNJ

120 Albany Street, Tower II, Suite 850

New Brunswick, NJ 08901

rponce@njhf.org

The New Jersey Chronic Fatigue Syndrome Association Medical Student

Scholarship at the University of Medicine and Dentistry of New Jersey

2010 APPLICATION FORM

PART A: APPLICANT INFORMATION

To be completed by applicant (please type).

Name: ________________________________________________________

Sex: M______ F ______

UMDNJ School: ________________________________________________

Class of: ______________

UMDNJ Academic Standing: ______________

Date of Birth: ____________________

Place of Birth: _________________________________

U. S. Citizen: Y ____ N ____ Marital Status: Single ________ Married _______

Permanent Legal Address:

_______________________________________________________________
Number Street

_______________________________________________________________
City State Zip Code

Mailing Address: (Leave blank if same as permanent address)

_______________________________________________________________
Number Street

_______________________________________________________________
City State Zip Code

Home Phone: ____________________________________________________________
Area Code Number

Local Newspaper: ________________________________________________________
Name Address

PART B: APPLICANT’S ACADEMIC ACHIEVEMENTS (please list and include awards/honors):

_______________________________________________________________________

________________________________________________________________________

PART C: APPLICANT’S COMMUNITY INVOLVEMENT (please list volunteer activities or other forms of community service performed beyond high school)

_______________________________________________________________________

________________________________________________________________________

PART D: APPLICANT’S WORK EXPERIENCE (please list work experiences performed beyond high school)

Dates of employment Name of Employer: Position Hours Worked

________________________________________________________________________

PART E: STUDENT BIOGRAPHICAL/PERSONAL STATEMENT (Please attach optional photo here)

Write a brief biography emphasizing why you decided to pursue a career in medicine and what are your career goals and aspirations.

Signature of Applicant

PART F: Essay

· Write an essay of approximately 4,500 words on the indicated question on the following page entitled: 2010 Question With Case History.

· Your essay must not exceed 15 double-spaced pages of 12-point type with 1-inch margins.

· References should be cited within the text of the essay using standard, medical journal format.

· No more than 40 references should be cited.

· A bibliography containing all references cited in the essay should be included at the end of the essay.

· The bibliography should be formatted using standard, medical journal format.

· The document needs to be scholarly and well-referenced. Cite references only from the peer-reviewed literature.

· The essay must not have been offered or submitted elsewhere.

· Essays not conforming to these standards will not be considered.

· A committee will be formed by NJCFSA to review the submitted essays and select the winner. Essays will be judged anonymously. Judging will be on the basis of scholarship, and the demonstration of understanding the difficulties involved in diagnosing and providing compassionate and effective care to CFS patients.

Essay Question with Case History

A patient recently diagnosed with a psychosomatic disorder by another physician requests a second opinion from you as to the cause of her debilitating illness and requests a thorough evaluation. She believes, based upon her research on the internet, that her symptoms are consistent with a diagnosis of Chronic Fatigue Syndrome. How would you proceed?

A summary of her medical history is as follows:

A 35-year-old female has come to your office for a second opinion and possible treatment. She states that she was healthy until one morning two years ago, when she woke feeling as if she had the flu with a sore throat and body aches. She felt unable to get out of bed because of lightheadedness upon sitting.

After a week, her symptoms improved to the extent that she was able to return to work although working exhausted her. She attempted to increase her stamina by exercising at her local gym. On days subsequent to exercising she felt worse physically and had difficulty concentrating. She stopped exercising.

For the past two years she has continued to feel exhausted. She has difficulty in falling to sleep at night and wakes up feeling un-refreshed. She continues to have difficulty in concentrating and gets frequent headaches and dizziness. She can't walk far because her legs feel weak. If she rests a lot, she feels slightly better, but will relapse with a return of all symptoms after any exertion.

After several warnings about frequent absences from work and the substandard quality of her work, she lost her job. She became depressed and anxious. She has seen her primary care physician on several occasions. He ordered routine blood tests, CBC with differential, sedimentation rate, routine chemistry, thyroid screen and a chest x-ray. He told her that all her test results fall within the normal range and he can find no physical illness to account for her debilitating symptoms. He prescribed an antidepressant medication. The medication made her feel worse, so she stopped it.

A year after the onset of her illness, her husband abandoned her because “she was no longer the woman he married.” She needs to apply for social security disability benefits and has obtained a report from her doctor. The report states that she is suffering from a psychosomatic disorder.