Summer Research Elective Credit Pre-­‐Approval Form You may apply for 4 weeks of elective credit for Summer Research conducted between the first and second year of medical school, provided: a) you complete 8 weeks of continuous research; b) the research is hypothesis driven and is pre-­‐approved by the Director of Medical Student Research; c) you subsequently submit a Documentation of Research form for final approval. Deadline: The present form should be submitted at least two weeks before the start of your Research Experience.
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: PreApp_Class_LastName.pdf (e.g. PreApp_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 Date: Student Information: Male
Female
Name: Continued on next page. Describe the problem to be s tudied and why it is scientifically/clinically important. Max words -­‐ 175 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. Max words -­‐ 550 Briefly describe what you personally will do, what the anticipated results may be, and how you will analyze the results. How will this work be funded? Check all that apply: Federal Work-­‐Study Program CTSC Award Mentor/PI/Lab Funding Unfunded Extramural Agency (Foundation/Society/NIH) Please specify: What is the nature of this project? Check all that apply: Basic Science Clinical Medicine Community Health Global Health Epidemiological Medical Ethics Other (Specify): Mentor Approval: By signing this form, I certify that I have read and approve of the above plan of study and I agree to serve as a mentor for the student submitting the form for the duration of the proposed project dates. I also certify that I have read the learning objectives associated with the Summer Research Elective, which can be found at: http://weill.cornell.edu/education/curriculum/summer_research_experience_lo.html Name:
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Name: Plan Approval: (For use by Office of Medical Student Research or Curriculum Office only.) Name:
Name: Date:
Signature: Signature: