Banner Image
 
 
 

All Application Materials Must be Received
ELECTRONICALLY
by Friday, February 8, 2008

Your electronic application must include all items below to be considered for the Summer Institute!
1.

    I confirm that I am a U.S. citizen or a non-citizen with permanent resident status.  Yes:  No:  *


    I also state my understanding that the Summer Institute can accommodate only a limited number of applicants and that an applicant who fails to attend after acceptance denies another worthy applicant the opportunity to participate. Therefore, I assure the National Institutes of Health that, if accepted, I will participate in the full program and attend all lectures and group sessions of the Summer Institute from 6:00 PM on July 13 to 3:00 PM on July 25, 2008.  *

2.

    Personal Statement indicating the basis of your interest in the Institute, your research goals, and how the course would be beneficial to your pursuit of those goals. (Two pages maximum, attached as a Word .doc or Acrobat .pdf file)

3.

    Sponsor Letter from someone who is familiar with you and your research. (Two pages maximum, attached as a Word .doc or Acrobat .pdf file. If your sponsor prefers to mail a hard copy, please contact Ms. Monica Duda for further instructions at mduda@blseamon.com or 301-577-0244, ext. 56)

4.

    Personal/Contact Information:

    First Name:
    		Last Name:
    Professional Title:
    		Department/Division:
    Terminal Degree (Ph.D., M.D., M.P.H., etc.):
    (If you have >1 terminal degree that you believe relevant (e.g., M.D., M.P.H.), please include both)
    		Year of Terminal Degree(s):
    University/Institution:
    		E-mail:
    Phone:
    		Fax:

    Current Address
    University/Institution:
    Department:
    		Building/Rm:
    Street Address (PO Box):
    City:
    		State:
    ZIP Code:
    		 

    Your March/April 2008 Address (if different from current address)
    University/Institution:
    Department:
    		Building/Rm:
    Street Address (PO Box):
    City:
    		State:
    ZIP Code:
    		 
    Publication Record:
    5.

      Curriculum Vitae: Please provide your CV and insure that it includes the following

    1. Educational and Work Experience
    2. Main Areas of Research Interest (3-5 key words)
    3. Grant-Support Record

      List any grants on which you have been listed as a co-investigator or principal investigator. Give the funding agency, the period of support, and the direct costs (not the total or the total direct costs). Provide two separate sections, one for NIH grants, the other for non-NIH grants.

    4. Research Experience

      For each research experience you deem relevant, please give a one sentence overview of what the study was about and what methodology was used (e.g., was it a laboratory experiment, an epidemiological analysis, etc. [Report clinical trials experience separately; see next section]; Then, very briefly describe your role(s) on the project, including the duration of your involvement.

    5. Previous Clinical Trials Experience

      If you have had prior experience with clinical trials, please give a brief overview (a couple of sentences) of what the trial(s) was (were) about. Provide the nature of the intervention(s), the control group(s) used, the outcome measures, and the study duration for research participants. Then, very briefly describe your role(s), including the duration of your involvement.

    6. Your Current Environment

      Please describe the resources in your environment that are available to you to aid you in becoming an independent clinical trialist.

    7. Publication Record

      • List non-empirical papers (e.g., reviews or description of a model or process) and empirical papers (e.g., reports of experiments, epidemiological studies, controlled trials) each in separate sections.
      • Please list publications by year, with most recent publications listed first.
      • Your name in the author list should be bold.
      • Include only papers that already have been published or are in press or in peer-reviewed journals. Please do not include book chapters, letters to the editor, case studies, books, abstracts, poster presentations, or oral presentations.