FellowshipsSemel Institute for Neuroscience and Human Behavior 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date of your application and the requested year at the top of the form.
3. Fill in your full name, including last, first, and middle names. Provide both your present and permanent mailing addresses.
4. Complete the contact information section with your current PG year, telephone numbers, email address, place of birth, and visa status if applicable.
5. Detail your USMLE scores by entering the dates and scores for Steps I, II, and III. If applicable, include COMLEX scores as well.
6. List your letters of reference by providing names and contact details for each referee as specified in the form.
7. Document your educational background by filling out sections for undergraduate and graduate education along with any postgraduate training.
8. Provide information about relevant work experience, research interests, publications, honors/awards, and professional memberships in the designated sections.
9. Complete attestations regarding malpractice claims or license issues as required. Ensure you sign the applicant's affidavit at the end of this section.
10. Finally, specify a week for interviews and provide an email or fax number for confirmation before submitting all required documents to Ron Lopez via email or mail.

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