Career Development Award Grant Writing Workshop Series
Health Services Research Center
Full Name
*
First Name
Last Name
Primary Email
*
example@gmail.com
Secondary Email (if any)
example@example.com
Preferred Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Academic Degree (select all that apply)
*
DDS/DMD
DNP
DO/MD
DPT
MA/MS
MPH
PhD
PharmD
PsyD
Other
Primary Institution
*
Primary Department
*
Primary Mentor's Name
*
Primary Mentor's Email
*
example@example.com
NIH Biosketch (Applicant)
*
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NIH Biosketch (Mentor)
*
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Describe three aims with hypotheses and brief methodological approaches
*
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Letter of Support from Primary Mentor
*
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The letter of support should include the applicant's potential to be an independent investigator in health services research and mentor's commitment to working closely with the applicant on the grant, including weekly or biweekly meetings.
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