PRISM 2024 Letter of Intent Form

Program for Research Initiated by

Students and Mentors (PRISM)
Letter of Intent Form
Letter of Intent Deadline: Tuesday, January 23, 2024

Please submit this Letter of Intent (LOI) for applying to the PRISM program prior to submitting the application packet. (LOI is strongly encouraged, not required.)

LOI includes the following information:
- Student name.
- Mentor(s) name and department.
- Tentative project title or topic (long description is not needed).
- Whether human participants/data are involved (IRB protocol) or animal subjects are involved (IACUC protocol).
- Status of applicable IRB or IACUC protocol.
- Whether the VA medical center or VA patient data is involved.
- (If you do not have a mentor yet, you can chose "I am deciding on a mentor" for "Current Mentor & Project Status")
You will received an email confirmation of the content you submitted for your LOI. Your mentors will also receive a copy. Please make sure all email addresses are entered accurately.

If you would like to make any modification or updates to you responses after submission, you can use the Edit Link included in your confirmation email.
I plan to apply to the 2024 PRISM program.
First Name (Student Applicant)*
Last Name (Student Applicant)*
E-mail (Student Applicant)*
I am currently a first year medical student at the University of Maryland School of Medicine.
Only first year medical students currently enrolled at the University of Maryland School of Medicine are eligible for the program.
I have a mentor and a projectI have a mentor and we are in the process of narrowing down a projectI am deciding on a mentor
- First Name (Main Mentor)*
- Last Name (Main Mentor)*
- E-mail (Main Mentor)*
- Department (Main Mentor)*
- YesNo
- First Name (Co-Mentor 2)*
- Last Name (Co-Mentor 2)*
- E-mail (Co-Mentor 2)*
- School or Institution if not UM SOM (Co-Mentor 2)*
- Department (Co-Mentor 2)
- YesNo
- First Name (Co-Mentor 3)*
- Last Name (Co-Mentor 3)*
- E-mail (Co-Mentor 3)*
- School or Institution if not UM SOM (Co-Mentor 3)*
- Department (Co-Mentor 3)
- Tentative Project Title or Topic*
- My intended research involves human participants or data (IRB protocol).I am currently not sure if my intended research involves human participants or data.My intended research involves animal subjects (IACUC protocol).I am currently not sure if my intended research involves animal subjects.My intended research does not involve human participants or data nor involve animal subjects.
- The applicable IRB protocol for my intended research currently exists, and its approval dates are current for the research period (current IRB approval letter is available).The applicable IRB protocol for my intended research will be renewed through continuing review with minor modifications or no modifications.Approval is pending for a modified IRB protocol.Approval is pending for a new IRB protocol.The applicable IRB protocol falls under an exempt category for IRB review (IRB determination letter is available).The applicable IRB protocol does not need IRB review as determined by IRB (IRB determination letter is available).I am currently not sure about the status of the applicable IRB protocol.N/AOther
- The applicable IACUC protocol for my intended research currently exists, and its approval dates are current for the research period (current IACUC approval letter is available).The applicable IACUC protocol for my intended research will be renewed with minor modifications or no modifications.Approval is pending for a modified IACUC protocol.Approval is pending for a new IACUC protocol.N/AOther
- VA medical center facilities or VA patient data is involved in my intended research.My intended research does not involve VA medical center facilities or VA patient data.I am currently not sure if my intended research involves VA medical center facilities or VA patient data.
- My VA WOC process has been completed and approved.I am in the process of completing my VA WOC paperwork.I have not yet started on the VA WOC process.N/AOther
- Additional Comments related to the Letter of Intent
- Should be Empty: