Letter of Intent Form

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Fellowship and Residency Research
Program (FRRP)
Faculty of Medicine
American University of Beirut
Beirut, Lebanon
Tel: (01) 350-000 ext. 5776
Email: frrp-fm@aub.edu.lb
FRRP
LETTER OF INTENT
(To be completed by the “Physician-in-Training”)
Date

Type

Faculty Initiated
“Physician-in-Training” -Initiated
“PHYSICIAN-IN-TRAINING” DETAILS

Medical fellow

Resident
Name
FRRP #
Email
Department
Mobile #
Division
ADVISOR’S DETAILS
Advisor’s name
Title
Specialty
Mobile #
Email
Department
RESEARCH DETAILS
TITLE
OBJECTIVES (List Primary and Secondary objectives.)
METHODOLOGY (Provide a plan of design, implementation and analysis.)
RESEARCH SIGNIFICANCE (How will the proposed research contribute to science?)
LOGISTICS
Time required for proposal completion
Time required for conducting study
Work Plan: (Provide a detailed plan in terms of tasks to be done and time needed for each.)
“Physician-in-Training” signature
Date
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