HEMATOLOGY RESEARCH TRAINING GRANT
DEPARTMENT OF MEDICINE
UNIVERSITY OF MINNESOTA
TRAINEE APPLICATION
NAME:
DEPARTMENT:
PHONE:
FAX:
EMAIL:
MAILING ADDRESS:
CITIZENSHIP STATUS:
 U.S. CITIZEN
 PERMANENT RESIDENT
GRADUATE DEGREE:
 MD/DO (RESIDENCY COMPLETED)
 PHD
INSTITUTION GRADUATE DEGREE RECEIVED FROM:
YEAR GRADUATE DEGREE RECEIVED:
SEND MATERIALS TO:
BARBARA PORWIT
HOT DIVISION, UNIVERSITY OF MINNESOTA
420 DELAWARE ST SE, MMC 480
MINNEAPOLIS, MN 55455
PORW0001@UMN.EDU
612-626-2446
612-625-6919 (FAX)
(LIST OF MATERIALS FOLLOWS ON PAGE 2)
Trainee Application
2/17/2016
Hematology T32
PLEASE ENCLOSE:
1. CURRICULUM VITAE
2. PERSONAL STATEMENT SUBSTANTIATING INTEREST IN HEMATOLOGY RESEARCH (INCLUDE YOUR DOMAIN OF
STUDY AS IT PERTAINS TO ONE OF THE FIVE IDENTIFIED AREAS OF FOCUS FOR THIS GRANT: TRANSPLANT
BIOLOGY/IMMUNOLOGY, VASCULAR BIOLOGY, STEM CELL BIOLOGY/GENE THERAPY, THROMBOSIS
HEMOSTASIS/RED CELLS, OR MALIGNANT HEMATOLOGY BIOLOGY/TRANSLATIONAL SCIENCE)
3. RESEARCH AND CAREER PLAN
4. SUMMARY OF PREVIOUS RESEARCH ACTIVITY
5. COPIES OF PUBLICATIONS
6. TRANSCRIPT FROM MEDICAL SCHOOL (OR GRADUATE SCHOOL IF APPLICABLE)
7. LETTERS OF RECOMMENDATION (3) (CAN BE SENT SEPARATELY)
a. ONE LETTER MUST BE FROM YOUR PROPOSED MENTOR. IN IT, THE MENTOR MUST ADDRESS:
i. YOUR QUALIFICATIONS AND COMMITMENT TO ACADEMIC RESEARCH
ii. TRAINING RESEARCH PLAN AND MENTOR’S FACILITIES TO CONDUCT IT
iii. YOUR POTENTIAL FOR LONG TERM ACADEMIC SUCCESS
Trainee Application
2/17/2016
Hematology T32