FOCUSOBGYN Women’s Health Scholar Certificate Program
Final Reporting Guidelines
Component IV: Women’s Health Scholarly Pursuit Project
Submit to: Dr. Hillary Bogner (Hillary.bogner@uphs.upenn.edu)
cc: Patricia Scott (pscott3@mail.med.upenn.edu)
Student Name: __________________________________________________________
Tel #_________________
Pager # ___________________
Email _________________
Title of Project: _____________________________________________________________
Timing of Project: Start Date _______________ End Date _______________
Total Time: _____ months (minimum, 3 months)
Faculty (or Community) Mentor(s): ___________________________________________________
Dept/Div ___________________
Tel #
_________________
Academic Rank ________________________
Email
(If faculty)
_________________
(Faculty or Community Mentor) I have reviewed the following project report:
Signature of Faculty Mentor____________________________________________
Date Signed __________________
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Component IV (Scholarly pursuit project)
Upon completion of this Certificate component, submit the completed form above; the documents required for the
Scholarly Pursuit Project (5-10 pages) and additionally include a one page summary of your experience per the guidelines
below.
Please summarize what you did during your scholarly pursuit experience - include all activities (IRB, research meetings,
and conferences, manuscripts submitted, presentations delivered, posters, etc.) and address the following questions (one
page).
 What do you feel you learned from this concentrated period of research in women's health?
 Do you feel your research was successful and do you envision continuing research in the future?
 Do you have any suggestions for the future of this project?
 How has this experience potentially impacted you and your career in medicine?
 How can we improve the Certificate program?
Submit to: Dr. Hillary Bogner (Hillary.bogner@uphs.upenn.edu)
cc: Patricia Scott (pscott3@mail.med.upenn.edu)
Within a month following completion of this component, in order to receive credit toward this component of the
certificate you must inform Susan Primavera (sprimave@mail.med.upenn.edu).
2.17.2011