(11/2015)
You may apply for 4 weeks of elective credit for Summer Research conducted between the first and the 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:
This form should be submitted at least three 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:
First Name:
Email Address:
Last Name:
Sex (check one):
Class (YYYY):
Male Female
Plan of Study:
Tentative Project Title:
Proposed Dates
Mentor Information
Name:
Title:
Department:
Institution:
Start Date: End Date:
Address:
Phone Number:
Email Address:

Plan of Study: (continued)
Background/
Significance:
Max words - 300
Describe the problem to be studied and why it is scientifically/clinically important.
Aims/
Hypothesis:
Max words - 175
Explicitly state the principal aims of the study and the hypothesis that you propose to test.
Methods :
Max words
–
250
As appropriate, describe study type, sample selection, inclusion criteria, techniques, materials, experimental design, study variables, outcome measures, etc.

Plan of Study: (continued)
Data Analysis/
Anticipated
Involvement:
Max words - 550
Briefly describe what you personally will do, what the anticipated results may be and how you will analyze these results.
How will this work be funded?
Check all that apply:
Unfunded Federal Work-Study Program CTSC Award
Extramural Agency (Foundation/Society/NIH), Please specify:
What is the nature of this project?
Check all that apply:
Mentor/PI/Lab Funding
Basic Science
Epidemiological
Clinical Medicine
Medical Ethics
Community Health
Other (Specify):
Global Health
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 confirm 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: Date: Signature:
For use by Office of Medical Student Research or Curriculum Office only.
Plan Approval:
Name: Date: Signature: