UC Davis Center for Healthcare Policy and Research

T32 Quality, Safety, and Comparative Effectiveness Research Training (QSCERT) Program

Application

Applications must be submitted in a single file,with CV, via email to:

Teresa Duran, MS,

Two letters of recommendation and mentor letter (if available) can be attached or sent separately.

Transcripts will also be required.

Questions only to: Joy Melnikow, MD, MPH ()

Patrick Romano, MD, MPH()

Deadline for Submission: Monday, December 1, 2015

Funding Period: Three (3) Positions July 1, 2016 – June 30, 2018

See Call for Applications for full details at (link needs to be updated)

Applicant’s Name:

e-mail address:

Phone:

Please have official transcripts sent to:

Teresa Duran, MS

CHPR

2103 Stockton Blvd.

Sacramento, CA 95817

Applicant Information

  1. Please describe your research interests and the importance of this training program (and mentor, if identified) to your career goals. This is your opportunity to describe why you are a strong candidate for Quality, Safety, and Comparative Effectiveness Research training support.
  1. Please include a short description of any previous research experiences and training. If you have completed a research thesis or dissertation, please briefly summarize that work.
  1. If developed, please describe your Research Plan for the fellowship period. This should include a statement of the problem that interests you, hypotheses to be tested,preliminary work that you have performed, and experimental designs that you would like to implement. If you have not yet developed a specific Research Plan, please provide as much additional information as you can about your proposed research and/or research interests (limit 1 page)

Mentor Information

Proposed Mentor: If you have identified a Mentor, please fill out the information in the space provided below. If you have not yet identified a Mentor, please contact or to receive help in identifying potential Mentors:

Title:

Department

e-mail:

Phone:

To be completed by proposed Mentor:

Research Focus:

Prior Experience with Trainees:

Describe research training for applicant (please be specific):

Have Transcripts sent to:

Teresa Duran, MS

UC Davis Center for Healthcare Policy and Research

2103 Stockton Blvd.

Sacramento, CA 95817

Applications, including letters of recommendation, must be submitted in a single file via email to:

Teresa Duran, MS

NO PAPER SUBMISSIONS

DEMOGRAPHIC INFORMATION (For Grant Reporting only)

Age: ______

Gender: ____M ____F

Are you of Hispanic or Latino origin or descent?

___yes___no

What is your race? Mark all that apply.

___Asian___White___Black or African American

___Native American or Alaskan Native

___Native Hawaiian or other Pacific Islander

___Other (Please Specify) ______

Citizenship:

___United States

___Other (Please Specify) ______