Request for Research Year/Fellowship Year/Extended Discovery

Class of 2016

Once you decide to do a year of research in any format, please read and complete this form and bring it to meet with Dr. Felner about your schedule. Make sure you are clear about and agree to the requirements below. Both you and Dr. Felner should sign off on this below. When you meet with Dr. Eley to discuss your plans, have him signthis form. Then meet with Dr. Powers to go over specifics regarding your schedule and the Discovery requirements and have her sign this form. Finally the form should be submitted to Matt Scott.

1. Student name: ______

2. This request is for (check the relevant description):

A research year at Emory with an Emory faculty member mentor ______

A research year at another site with an Emory faculty member mentor ______

A research year at another site with a non-Emory faculty mentor ______

A year of research under a formal fellowship program ______

Name of fellowship program ______

Administrative contact for fellowship program ______

3. Name and position of proposed mentor:

Name: ______

Title: ______

Dept: ______

Institution: ______

Email: ______

4. Dates of planned research:

Start: ______

End: ______

5. Briefly describe your plans and goals for this research experience:

Students doing a year of research, whether or not they have a Fellowship, will receive 5 months credit for Discovery. As a result this year is also described as “Extended Discovery” and you may see this on some documents.

Because you will receive 5 months of academic credit, you will need to complete some of the requirements of Discovery. See the list of requirements below. You will now graduate with the Class of 2017, so the deadlines for your final submissions (paper, presentation at Research Day, and evaluations) will be those of the Class of 2017.

Extended Discovery Requirements

1. Submit a title and brief description of the research project (1-2 paragraphs, 2000 character limit) and your proposed mentor’s NIH style biosketch or CV with funding information to Sherice Henry (). This should be done as soon as you have developed a plan for your research year.

2. Submit a 2 page research proposal detailing your project. This is a requirement for many fellowship programs. If their specifics are somewhat different from those of Discovery, we can work with you on this. Some programs do not require this proposal until after you start under the fellowship; again we will work out a reasonable timeline. Please contact Dr. Powers to arrange specifics of this.

3 SoCRATES: you should have attendedSoCRATES part 1 along with your class. If you are in town and on your research project during part 2, you should attend. If you are out of town on your project or on an elective at the time of part 2, you can complete it online. DO WE WANT TO BOTHER HAVING THEM DO SOCRATES ONLINE? HAVE NOT DONE IN THE PAST.

4. IRB approval will be obtained by your mentor through the host institution.

5. CITI training is typically required to be done through the host institution. Emory does not accept training certified at another university and this is true for most universities. You will complete this training or equivalent under the guidelines of the host institution.

6. You will not receive a midpoint evaluation but please be aware that you are welcome to contact the Discovery program Director(s) at any time if you need assistance or advice.

7. You will complete a final Discovery paper that should be conform to the Discovery paper guidelines. If a final paper is required for your fellowship program we will work with you given their requirements so that you do not have to write two papers. If you are the first author of a manuscript and were responsible for the first draft, this can be submitted as your Discovery paper. Your paper will be due January 16, 2017 (tentative date)

8. We will request an evaluation from your research or fellowship mentor.

8. You will present your research in the form of a talk or poster at Research Day, April 20 2017 (tentative date).

Extended Discovery grading:

Research Proposal15%

SoCRATESundecided

Mentor Evaluation10%

Timeliness10%

Final Paper60%

Signatures

______Date: ______

Dr Joel Felner, Associate Dean for Clinical Education

______Date: ______

Dr. J. William Eley, Executive Vice Dean for Education

______Date: ______

Dr. Maureen Powers, Director, Discovery Phase

______Date: ______

Student

RETURN THIS COMPLETED AND SIGNED FORM TO MATT SCOTT.

FOR OMESA INTERNAL USE ONLY