COLLEGE OF SCIENCE AND ENGINEERING Masters of Science in Applied Clinical Research Instructor Interest Questionnaire Thank you for your interest in becoming an instructor for St. Cloud State University’s Masters of Science in Applied Clinical Research (MS-ACR) degree program, part of the Academic Center for Regulatory Affairs in the College of Science and Engineering. In order to help us identify which courses are the best fit for your background and experience, we ask you to complete this questionnaire. The current course descriptions are available in the ACR Course Narrative located here. After reviewing this questionnaire and the course descriptions, if you are interested in applying to become an instructor, please send the completed survey to the email addresses below and complete online at application. Note that guest speakers do NOT need to complete the online application. If you have any questions, please contact the Program Director, Patty Feulner. Please send the completed survey to: Patty Feulner Associate Director, Applied Clinical Research Graduate Program St. Cloud State University pefeulner@stcloudstate.edu 612-272-3874 (cell) -ANDJulie Nienaber Office of the Dean of the College of Science & Engineering St. Cloud State University jmnienaber@stcloudstate.edu 320-308-2167 (office) COLLEGE OF SCIENCE AND ENGINEERING MS-ACR Instructor Interest Questionnaire: 1. Contact Information: Name: Organization: Title: Phone: Email: 2. Medical Device Expert Areas (sufficient to teach Clinical Research professionals): Anatomy, Physiology, Pathophysiology (620) Biostatistics (624, 626, 630) Clinical study design (624, 626, 630) Protocol development (630) Good Clinical Practices (628, 630, 632) Clinical trial management (628, 630, 632, 634, 636) Clinical risk management (622, 628, 632, 634, 636) Clinical safety & efficacy (630) International trial design & execution (630, 632, 640) Clinical trial analysis & reporting (624, 636) Data monitoring committees & adverse event analysis (632, 634, 636) Medical device product lifecycle & commercialization (622) Evidence based medicine (626) Clinical research regulations & compliance (628) Study Monitoring & Auditing (632, 636) Research ethics (628, 640) Clinical research leadership (640) External committee leadership (640) Postmarket Studies (630, 632) Other: 3. Type of instructor role(s) you are interested in: Course lead instructor (paid): ACR#: (course numbers) (Lead instructors are responsible for the overall delivery of course content, are the primary contact for students, establish student grades, and typically teach a significant portion of the course content.) Co-lead instructor (paid) ACR#: (Co-lead instructors share the lead instructor duties with one other instructor) Full 4 hour session instructor (paid): ACR#: (A session instructor is responsible for delivery of course content during one or more 4 hour class sessions.) Guest speaker (unpaid) less than 4 hours/term: ACR#: (Guest speakers speak for a fraction of one session – usually on a very specific topic and do so with the lead or co-lead instructor present.) 4. Are there specific courses/topics you are interested in teaching? COLLEGE OF SCIENCE AND ENGINEERING 5. Timeframe preference: (check all that apply) Monday-Thursday Evenings: 5:00 – 9:00 pm Friday Evening: 5:00 – 9:00 pm Saturday 9:00 am – 1:00 pm Comments: 6. Semester Preference: None Summer Fall Spring Comments: 7. Do you have experience as an instructor? Yes No If yes, describe: you can include a reference from the place of instruction, please do so.) (If