Information for Appointment to Training Program

Information for Appointment to Training Program

NIDDK T32 – DK062710 – Summer Research Training for Medical Students

Full Name:
Degree(s), Institution(s), Year(s):
Permanent Address:
City: State: Zip:
Home Phone:
Mobile Phone:
Personal Email address:
Social Security Number:
Date of Birth:
Ethnicity (check one) / Gender:
☐American Indian/Alaskan Native / ☐Male
☐Asian or Pacific Islander / ☐Female
☐Black, not of Hispanic origin
☐Hispanic
☐White, not of Hispanic origin
☐Do not wish to answer
Are you a US Citizen or Permanent Resident?
Are you a scientist with a disability?
Have you ever engaged in or been judged by an official body to have engaged in scientific misconduct?
Are you in a dual degree program currently?
Expected completion date of current program?
Have you previously been appointed as a predoctoral trainee on an NRSA training program (F32/T32)?
Printed documentation that the following training courses have been completed after your appointment (see attached instructions) is required: Once you complete the training, you will see an acknowledgement reflecting completed training. Please do a “Print Screen” at that point and include it with the other documentation.
a. HIPPA Training (
b. Research Code of Conduct (Go to UAB home page under Research, select Compliance,then select in the left sidebar Research Code of Conduct – Follow instructions).
c. If you have not done so already, please ALSO provide IRB/IACUC training certification (if applicable for your
research)
Research Focus for Summer Project: (input 4 digit number from attached list of choices for research training)
Education after high school (provide the following for EACH institution attended):
Institution – Dept and Location. / Degree(s) Received / Month/Year / Major Field
MCAT score OR DAT Score:
MCAT DAT
Verbal
Physical
Biological
Writing
Appointment Period (choose only one)You can begin your work as early as May 29, 2016 and end as late as August 20, 2016. You must be in the program a minimum of 8 weeks. Please indicate the expected start and end dates.
8 weeks
10 weeks
12 weeks
Start date: ______End date: ______
Please send this form, along with a copy of your resume/CV to Jeff Allison, AND Eva Gilliam, .

Applicant’s signatureDate

Summer Research Fellowship Agreement

I am a student in good academic standing.
I am not a holder of a Master’s or Ph.D. degree from a program in the biomedical sciences that included research experience.
I am not currently enrolled in a program leading to a Master’s or Ph.D. degree in biomedical research.
If I am selected to receive a Summer Research Fellowship, I agree to present my findings (negative or positive) at the Dale J. BenosMedical Student Research Day (October 2016) competition (UAB student awardeesonly) andsubmit an abstract and present a poster of my work at the Vanderbilt University STRP Symposium in Nashville TN August 3-August 4, 2016 (all student awardees). My advisor and I also understand that one of our goals is to have the results of my summer research included in a subsequent publication from my advisor’s laboratory with the acknowledgement of the student contribution as co-author.
I will attend summer seminar programs pertaining to my research. I will attend the summer seminar series entitled“Understanding the Research Enterprise.”
I independently wrote this T35 Research Proposal.
All the information I have provided in this application is true.

Signature of applicant Date

I am willing to accept this student in my laboratory and will take responsibility for his/her participation in the Medical Student Research Day, or the STRP Symposium. If this student’s work is selected for oral presentation or as a category winner at MSRD, I agree to provide an honorarium for that student’s accomplishments ($100-200). I certify that my role in this T35 Research Proposal was as an advisor, and that the proposal was written in full by the student.

Signature of faculty sponsor Date

Printed name of faculty sponsor

Mentor’s Information

Mentor’s email Campus Phone

Department

CampusAddress

Title of Project

SUMMER RESEARCH PROJECT PROPOSAL

Preferred font: Arial 11
Single space
Do not exceed 5 (five) pages for sections A through D
Be brief, but do not sacrifice clarity for brevity. Observe the following outline and use the suggested headings in your narrative.

A.Specific Aims (limited to 1 page)

State concisely the goals of the proposed research and summarize the expected outcome(s), including the impact that the results of the proposed research will exert on the research field(s) involved. List succinctly the specific objectives of the research proposed, e.g., to test a stated hypothesis, create a novel design, solve a specific problem, challenge an existing paradigm or clinical practice, address a critical barrier to progress in the field, or develop new technology.

B.Introduction

This section should contain background information relevant to the project.

C.Research Strategy

Organize the Research Strategy in the specified order using the instructions provided below. Start each section with the appropriate section heading.

(a) Significance

•Explain the importance of the problem or critical barrier to progress in the field that the proposed project addresses.

•Explain how the proposed project will improve scientific knowledge, technical capability, and/or clinical practice in one or more broad fields.

•Describe how the concepts, methods, technologies, treatments, services, or preventative interventions that drive this field will be changed if the proposed aims are achieved.

(b) Approach

•Describe the overall strategy, methodology, and analyses to be used to accomplish the specific aims of the project. Include how the data will be collected, analyzed, and interpreted.

•Discuss potential problems, alternative strategies, and benchmarks for success anticipated to achieve the aims.

•If the project is in the early stages of development, describe any strategy to establish feasibility, and address the management of any high risk aspects of the proposed work.

If there are multiple Specific Aims, then you may address Significance and Approach for each Specific Aim individually, or may address Significance and Approach for all of the Specific Aims collectively.

D.Literature Cited (3 -10 papers)