Institute for Translational Sciences – Education Office
Translational Research Scholars Program (TRSP)
Associate Application Instructions and Forms
(Updated: January 7, 2010)
How to Apply
Complete and submit the entire Translational Research Scholars Program application form.
Part I. Translational Research Scholars Program Application: Please complete all the items listed. You
will also need to provide a current curriculum vitae which should include an up-to-date list of
publications.
Part II. Personal Statement: Please limit your personal statement to a maximum of one page. Be sure to
include your background in clinical/translational research, your future career goals and how the TRSP
will help you accomplish those goals.
DEADLINE FOR APPLICATIONS: To allow adequate time for review, applications should be submitted at least
2 months in advance of the planned start date.
WHERE TO SEND APPLICATIONS AND MATERIALS:
Translational Research Scholars Program
c/o ITS Education Office
University of Texas Medical Branch
301 University Boulevard, Route 0342
6.174 Children’s Hospital
Review Process
After completion of the application materials, the TRSP Committee will review the Associate candidate’s
material. Decisions to accept candidates are made on the basis of the candidate’s interest and commitment to
a career in clinical/translational research.
Acknowledgement
The Translational Research Scholars Program (TRSP) is part of the UTMB Institute for Translational
Sciences Education Program, which is partially supported by a grant from the National Institutes of Health
(UL1RR029876).
Checklist The Translational Scholars Associate Application includes all the items listed below.
1. _____ Translational Research Scholars Program Application (Part I)
2. _____ Applicant’s updated curriculum vitae and Publications List (Part I)
3. _____ Personal Statement (Part II)
Translational Research Scholars Program
UTMB ITS Education Office
THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
Part I.
TRANSLATIONAL RESEARCH SCHOLARS PROGRAM
ASSOCIATE APPLICATION
1. Name:
First
Middle Initial
Last
2. Social Security Number:
—
—
If you do not wish to provide your SSN or you do not have one, an alternate number will be assigned by UTMB.
3. Current Address:
Number and Street, Apt. No., P.O. Box
City
State
Zip
Telephone:
Work Area Code
Work Phone number
Home Area Code
Home Phone number
Email Address:
4.
Permanent Address:
Number and Street, Apt. No., P.O. Box
Check here if
same as # 3.
City
State
Zip
Telephone: Area Code and Number
E mail Address
5. Previous Name(s): Other names under which records may be received.
A.
B.
6. Birthdate*:
8. Ethnicity*:
/
/
Hispanic or Latino
7. Gender*:
Male
Female
Non-Hispanic
9. Race*:
Black or African American
Native Hawaiian or Other Pacific Islander
White
American Indian or Alaska Native
Asian
More Than One Race
* This information is not required, and if provided, will not be considered in the admission decision. This will only be
used for completing required state and federal statistical reports.
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Translational Research Scholars Program
UTMB ITS Education Office
Applicant Name: ______________________________________________________________
Part I: Application (continued)
Please continue the application by answering the following questions.
Planned start date: ___________________________________________________________
Research Background:
Please attach a current curriculum vitae (CV) and list additional research activities that are not included on
your CV, such as:
Are you a member of a multidisciplinary translational team (MTT) within the Institute for Translational
Sciences? _________ If yes, which MTT? ________________________________
Are you planning work on a clinical or translational research project? If yes,
Project Title: ____________________________________________________________
Principal Investigator: _____________________________________________________
Funding Source: _________________________________________________________
Your role on project: ______________________________________________________
Are you currently working on a clinical or translational research project? If yes,
Project Title: ____________________________________________________________
Principal Investigator: _____________________________________________________
Funding Source: _________________________________________________________
Your role on project: ______________________________________________________
Have you previously applied for an NIH or other research grant? If yes,
Grant Title: _____________________________________________________________
Funding Source/Type of Grant: _____________________________________________
Date Submitted / Status: ___________________________________________________
Primary Mentor Name (If applicable):_______________________________________________
UTMB or other non-degree educational activities (not listed on your CV)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I certify that the information submitted in this application is true and complete.
Signature of Applicant: ______________________________________________
Date ___________
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Translational Research Scholars Program
Part II.
UTMB ITS Education Office
PERSONAL STATEMENT
Applicant Name: ______________________________________________________________
Personal Statement – Maximum of 1 page:
(Brief statement should address: a) background information relevant to the applicant’s interest and commitment
to clinical/translational research; b) your anticipated accomplishments in next 3-5 years and long-term career
goals and; c) how the Translational Research Scholars Program is seen as advancing these goals)
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