Summer Research Elective Credit Documentation of Research and Final Approval Form Use this form to complete your application for 4 weeks of elective credit for ≥ 8 weeks of Summer Research conducted between the first and second year of medical school. Deadline: This form may be submitted any time after the completion of your summer research experience and NO LATER than April 15th of the year you expect to graduate. Submission well in advance of that date is strongly encouraged. Instructions: 1) THIS FORM MUST BE COMPLETED IN ADOBE ACROBAT PRO, which can be found on the medical library computers. Download and save the form before filling it in. 2) Save the form with the following file name: FinalApp_Class_LastName.pdf (e.g. FinalApp_2019_Doe.pdf). 3) Obtain your mentor’s digital signature. Alternatively, a scanned copy of the hand-­‐signed signature page may be attached as a separate file. 4) Submit the electronic form (and, if needed, the scanned signature page) by email to: medstudentresearch@med.cornell.edu Male
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Name: Continued on next page. Describe the problem to be s tudied and why it is scientifically/clinically important. Explicitly state the principal aims of the study and the hypothesis or hypotheses you propose to test. As appropriate, describe study type, sample selection, inclusion criteria, techniques, materials, experimental design, study variables, outcome measures, etc. (Continued on next page.) Briefly describe your results, data, or observations, and how they were analyzed. Briefly describe the conclusions of y our studies and their significance, as well as potential next steps for the project. You may also use this section to describe any technical difficulties or unforeseen problems with completing the project as originally described in your Pre-­‐Approved study plan. Specific Involvement: Max words – 175 Briefly describe your specific involvement in the project (e.g. conducted experiments, recruited subjects, analyzed data, wrote manuscript, etc.) Continued on next page. Please provide any additional information that you deem relevant (optional). How was this work funded? Check all that apply: Federal Work-­‐Study Program CTSC Award Mentor/PI/Lab Funding Extramural Agency (Foundation/Society/NIH) Please specify: What was the nature of this project? Check all that apply: Basic Science Clinical Medicine Community Health Global Health Epidemiological Medical Ethics Other (Specify): Publications/Presentations: Please indicate if you have or you plan to submit your work for peer-­‐reviewed presentation or publication. Check all that apply. This work has been published. This work has been presented. This work has been submitted for publication. This work has been submitted for presentation. This work will be submitted for publication. This work will be submitted for presentation. Mentor Approval: By signing this form, I certify that I have read and verify the accuracy of the experience description provided in this form. I also confirm that I have read the learning objectives for Summer Research Electives, which can be found at: http://weill.cornell.edu/education/curriculum/summer_research_experience_lo.html Signature:
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