2008 Office of Medical Research Summer Fellowship Program application

Name

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Address

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Local Phone and Email Address

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Undergraduate institution, location, field of study and date of baccalaureate degree
 

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Graduate or professional school, location, dates attended, field of study and advanced degree, if applicable
 

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When did or when will you enroll in the University of Missouri-Columbia School of Medicine?
 

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Are you a Conley ( ) or Bryant ( ) Scholar?
 

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Project title

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Name of department of faculty sponsor:

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Beginning and ending dates of the project:

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On the back of this form provide the following information (this should not be a reiteration of the mentor's research description):

Consise background and signficance of the proposed project

Hypothesis the project will test

Specific aims of the research proposal

Role of the student/trainee in the project

In signing this application, the student and sponsor agree ensure that the fellowship recipient will present a poster during Health Sciences Research Day in Fall, 2008. By signing this form, the faculty sponsor is making a commitment to support $1,000 of the $2,100 research fellowship, should it be awarded. A fund code for this match will be required prior to the release of funds from the Office of the Dean.

Student signature

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Faculty Sponsor Name (please print)

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Faculty sponsor signature

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IRB Approval # (required if project involves research with human subjects)

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