Heme Scholars in Non-Malignant Hematology
K12 Clinical Research Career Development Program
APPLICATION FOR 2015-2016
1. Personal Information
Name____________________________________________________________________________________________
Last,
First
Middle (Name or Initial)
Home Address______________________________________________________________________________
Street
City
State
ZIP
Daytime Phone (10 digit)__________________________
Evening Phone (10 digit)__________________________
Other Phone (10 digit)____________________________
Email: _________________________________________
2. Equal Opportunity/Affirmative Action
We are required by NIH to collect the following information for reporting purposes. Washington University is committed to a
policy of equal opportunity. We welcome and encourage applications from underrepresented minorities, women and persons
with disabilities.
Gender
Male
Female
Date of Birth (mm/dd/yyyy): __________________
Citizenship
US Citizen
Non-Citizen National
Permanent Resident (Alien Registration Receipt Card
I-151, I-155 or other verification of permanent residency)
Race/Ethnicity (check all that apply):
American Indian or Alaska Native,
Black/African American,
Asian,
Native Hawaiian or Other Pacific Islander,
Hispanic or Latino/a,
White (Non-Hispanic),
Intentionally Withheld
3. Current Professional Position and Institutional Information
Academic Rank
Current Tenure Status
Clinical Fellow
Tenure Track
Postdoctoral Scholar
Clinical Track
Instructor
Research Track
Assistant Professor
Not Applicable/Not Assigned
Associate Professor
Professor
Other (explain)______________________________________________
Degree(s)
M.D.
D.O.
Pharm.D.
D.D.S.
M.P.H.
Ph.D.
Other________________
Institution_____________________________________
Department________________________________________
Division_______________________________________
Training Program (if any)____________________________
4. Statement on Concurrent Application for Other Career Development Grants
Please choose one of the following two options. Note the special obligation imposed on candidates with a concurrent grant.
I have a pending application (or plan to apply in October 2015 or February, 2016) for an individual NIH Career
Development Award (e.g. K01, K07, K08, K23), or an equivalent award. I understand that if I am chosen for the K12 program
AND the other application is funded, I will relinquish the K12 funding when the other award starts. I also understand that I am
encouraged to complete both the formal training and the informal curricular activities of the K12 program to the extent these
don’t interfere with my K23 career development plan.
OR
I am NOT currently applying for other individual career development awards (through October 2016).
Washington University K12 Heme Scholars in Non-Malignant Hematology
http://hemescholars.im.wustl.edu; tel (314) 362-9029; fax (314) 454-3012
Page 1 of 6
5. Applicant Career Development Plan
6. Applicant Research Plan
7. NIH Biographical Sketch
Attached (see instructions)
Attached (see instructions)
Attached (see instructions)
8. Division Chief or Program Director Letter(s) of Support
Attached (see instructions)
Name _______________________________________
Name 2 (optional) ______________________________
Department/Title______________________________
Department/Title________________________________
Phone_______________________________________
Phone________________________________________
Email_______________________________________
Email________________________________________
9. Letters of Reference
Letters from the following two references have been requested (see instructions)
Reference 1__________________________________
Reference 2 ____________________________________
Department/Title______________________________
Department/Title________________________________
Phone_______________________________________
Phone________________________________________
Email_______________________________________
Email________________________________________
10. Mentors and Letters of Support
Note: If you are proposing a mentor who is not currently on our roster of
mentors, contact us for information about how to proceed.
Proposed Primary Mentor (see instructions)
Name ________________________________________________ Department_________________________________
Phone ___________________________________ Email___________________________________________________
The proposed mentor has been asked for a letter of support and has been give the corresponding instructions.
Proposed Secondary Mentor (see instructions)
Name ________________________________________________ Department_________________________________
Phone ___________________________________ Email___________________________________________________
The proposed mentor has been asked for a letter of support and has been given the corresponding instructions.
Candidate’s Signature
___________________________________________________________
___/____/_________
Date
Contact information: Please contact Program Coordinator Susie Hahn (shahn@im.wustl.edu, 314-362-9029), or Program
Director J. Evan Sadler M.D., Ph.D., (esadler@im.wustl.edu) for questions about the application process.
Washington University K12 Heme Scholars in Non-Malignant Hematology
http://hemescholars.im.wustl.edu; tel (314) 362-9029; fax (314) 454-3012
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INSTRUCTIONS AND INFORMATION FOR K12 APPLICATION (2015-2016 forms, for admission in 2016)
Dear Prospective Heme Scholar,
Thank you for applying to the K12 Clinical Hematology Research Career Development Program at Washington
University. This innovative initiative of the NIH Roadmap, supported by the National Heart Lung and Blood Institute
(NHLBI), will prepare trainees (Heme Scholars) to address complex clinical and translational research problems in nonmalignant hematology. Scholars are expected to become independent researchers and assume leadership roles in non-malignant
clinical hematology.
The Heme Scholars program involves all of the hematology-related training programs at Washington University including
Hematology/Oncology, Pediatric Hematology/Oncology, Transfusion Medicine, and Hematopathology. The project office is
based in the Division of Hematology.
The elements of the program are timed to maximize opportunities for Scholars to apply new skills in their own research.
Up to one year is devoted to acquiring the fundamental knowledge needed to perform clinical research in non-malignant
hematology. The Clinical Core Curriculum covers the specific knowledge necessary to care for patients with specific nonmalignant hematologic diseases who may become subjects for clinical research. The Clinical Core Curriculum component is a
feature of NHLBI-funded K12 Clinical Hematology Research Career Development Programs that is not a part of other K12
programs. The Didactic Clinical Research Curriculum teaches the general skills necessary to conduct clinical research
effectively and ethically, with the option to earn a Masters of Science degree in Clinical Investigation. The balance between the
Clinical Core Curriculum and Didactic Clinical Research Curriculum components, and the total time devoted to them, will vary
depending on the prior training of Scholars. The program’s Advisory Committee is responsible for approving a curriculum that
meets the needs of each Scholar.
The Mentored Research Experience will begin as soon as feasible, during the first year if appropriate to the Scholar’s prior
training, and will enable Scholars to use the skills taught by the curriculum to design and perform a clinical research project.
Scholars will benefit from supervision by two skilled Mentors and oversight by a Scholar-specific Career Development
Committee that is analogous to a Ph.D. thesis committee. Additional key program features include seminars, symposia, journal
clubs, and clinical research meetings. Graduating Heme Scholars will be ready to lead, design, and conduct clinical research
and work effectively in collaborative multidisciplinary teams. This comprehensive approach will provide optimal training to
launch successful academic careers in non-malignant clinical hematology research. The major components of the program are
described in detail on the Heme Scholars website (http://hemescholars.im.wustl.edu/).
The successful scholar applicants will be chosen on the basis of:
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Demonstrated excellence in intellectual capability and past performance
Motivation and future potential for leadership in non-malignant hematology research
Quality of the proposed research program
APPLICATION DUE DATES AND START OF AWARD. We will be accepting applications for Heme Scholars July
2015 through mid-October 2015 with a start date of June 1, 2016. Earlier start dates can be considered to accommodate special
circumstances.
DEFINITIONS
Non-malignant hematology is broadly defined to include:
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Hematopoiesis and hematopoietic stem cell biology
Stem cell transplantation (excluding transplants solely for malignant disorders)
Disorders of red cells, leukocytes and platelets
Aplastic and hemolytic anemias
Hemoglobinopathies
Hemostasis, thrombophilia, and hemorrhagic disorders
Transfusion medicine (adult, pediatric, or both)
Myeloproliferative disorders (MPD), and myelodysplastic syndromes (MDS), including CML
Although myeloproliferative disorders (MPD) and myelodysplastic syndromes (MDS) are premalignant, and could be
considered “malignant,” they are disorders for which a hematologist would be consulted. Leukemias are excluded from this
Washington University K12 Heme Scholars in Non-Malignant Hematology
http://hemescholars.im.wustl.edu; tel (314) 362-9029; fax (314) 454-3012
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program.
Clinical research is broadly defined to include epidemiologic and natural history studies, translational research, patientoriented research, clinical trials, and health services and outcomes research. Patient-oriented research includes (1) mechanisms
of human disease, (2) therapeutic interventions, (3) clinical trials, and (4) the development of new technologies. This definition
of patient-oriented research is essentially the same as that applied for K23 grants. Conventionally, NHLBI has suggested the
“handshake test” in which researchers should need to shake hands with a patient at some point during the course of their
project. However, this test is not the sole means of determining eligible projects. Acceptable projects might or might not
include hands-on patient care, such as:
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Studies of mechanisms of disease (“bedside-to-bench” research)
Pre-clinical studies of disease treatment strategies
Outcomes research and epidemiology
Psychology studies related to compliance with therapy
Interventional studies aimed at health systems or physicians, rather than individual patients
Please address any questions about these definitions, and their implications for your specific training to program director
Dr. J. Evan Sadler esadler@im.wustl.edu; Tel: 314-362-9029
ELIGIBILITY
Heme Scholars must:
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Possess an MD or DO degree, or a doctoral degree in a related discipline
Be a US citizen, non-citizen national, or permanent resident
Commit 75% of full-time professional effort to the program for a minimum of 2 years.
Have two mentors and a commitment to a career focused on non-malignant clinical hematology or a specific blood
disease
Exclusions or Ineligibility Criteria:
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Scholar must not be a Principal Investigator on an R01 or component project of Program Project (P01) or Center
Grant (P50, P60 or U64), Mentored Career Development (K series) or equivalent research grant award. Candidates
may have had NRSA (F or T) or NIH small grant (R03).
Non-citizens or those with temporary or student visas are not eligible.
Additional Eligibility Information:
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Scholars should be clinical or research fellows, clinical or research instructors, or newly appointed assistant
professors.
Eligible physician Scholars usually will have training in Hematology, Hematology/Oncology, Pediatrics, Internal
Medicine, Pathology & Immunology, Transfusion Medicine, Hematopathology, Family Practice, Psychiatry, or
OB/Gyn
Physician Scholars should have completed residency training. Exceptions may include residents if they have worked
with a mentor in a hematology research project, or have published at least one paper on a blood disease.
Physician Scholars should meet any service requirements during the period of K12 support by caring for pediatric,
adolescent, or adult patients, with non-malignant or malignant blood diseases. They may not be assigned to solid
tumor, cardiology or stroke clinics. This must be attested to in the support letter from the Program Director or
Division Chief.
In addition, doctorally-prepared health professionals may be selected as Scholars if they have documented clinical or
research experience (e.g., a paper or dissertation) in one or more nonmalignant or malignant blood diseases.
Doctorally-prepared health professionals may come from clinical fields such as epidemiology, health services and
outcomes research, social work, nursing, nutrition, health education, pharmacology, neuropsychology, or psychology.
Note that NIH rules limit total K training grant career development support to 6 years. Thus, a two-year K12 recipient
can receive at most a four-year K23 or other K-type award.
BENEFITS
For Heme Scholars:
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Salary support of up to $75,000 each year, plus fringes, appropriate to the Washington University salary structure for
Washington University K12 Heme Scholars in Non-Malignant Hematology
http://hemescholars.im.wustl.edu; tel (314) 362-9029; fax (314) 454-3012
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persons of equivalent qualifications, experience and rank, for two or three years
$30,000 each year for research expenses, travel and tuition
Indirect costs of 8% are allowed
Opportunity to obtain a Master of Science degree in Clinical Investigation
Protected research time
Advice and oversight by a specific Career Development Committee, analogous to a Ph.D. thesis committee
Access to a multidisciplinary pool of highly qualified mentors who will guide research projects and career
development
For Primary Mentors:
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5% Salary support
Funds to travel to an annual one-day grantees’ meeting sponsored by NIH. Mentor salary support is a unique feature
of the K12 program in non-malignant hematology.
APPLICATION PROCESS
Please be sure you have provided all necessary information for the application. Font must be 11 points or larger (Arial or
Helvetica 11 point is preferred). Type must not exceed 6 lines per inch. Please do not staple the pages.
Checklist
Completed application form, 2 pages.
Applicant Career Development Plan (3-5 pages).
Applicant Research Plan (5 pages).
Current NIH Biosketch, including current and/or pending grant support (if any) and bibliography.
Letter from Division Chief and/or Program Director, attached to this application.
Two letters of reference sent directly to the program office.
Letter of support from the proposed primary and secondary mentors, chosen from the roster of K12 Heme Scholar mentors,
sent directly to the program office.
Specific Instructions
Sections 1-3. These sections are self-explanatory.
Section 4. Concurrent K01, K23, K08 applications. Please state on the application form whether you have already
applied, or plan to apply in October 2015 or February 2016, for an individual career development award (“K grant”). The
Advisory Committee assumes that if you are in this position, you are likely to opt for the longer, individual grant, if awarded,
when its funding period starts. Because the K12 application has a very short lead time this year, and K23 (and related grants)
have very long lead times of a year or more, taking into account possible need for revisions, candidates might be able to
complete some or all of the K12 program by the time an individual grant award could begin. The Advisory Committee requires
that candidates in this circumstance declare their willingness to continue to participate in hematology training aspects of this
program after their individual training grant begins. Please contact program director Dr. Sadler if you have questions about
this requirement.
Section 5. Applicant Career Development Plan (3-5 pages). Please provide a summary of your career development plan
that includes, but need not be limited to, the following points:
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What are your career goals?
What is your relevant past research experience and graduate coursework if any
What coursework do you plan to take and why?
Who your mentors are and why you have selected them?
How many years you anticipate being on the award?
What are your plans for the next 2-3 years if you do not receive the award?
How would the award change or affect your career plans?
This statement will not only be helpful in admission decisions, but will also help guide selection of a Career Development
Committee by the candidate in conjunction with the Advisory Committee.
Section 6. Applicant Research Plan (5 pages). Your research plan should follow the standard NIH structure and be no
more than 5 pages in length:
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Abstract – a one paragraph summary of the research plan
Washington University K12 Heme Scholars in Non-Malignant Hematology
http://hemescholars.im.wustl.edu; tel (314) 362-9029; fax (314) 454-3012
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Specific Aims – one concise paragraph or less is recommended
Background and Significance – briefly sketch the background leading to the present application, critically evaluating
existing knowledge, and specifically identify gaps that the project is intended to fill. Less than one page is
recommended.
Preliminary Data – little or no preliminary data are expected for career development program applications. No more
than one-half page is recommended.
Research Design and Methods – describe the research design conceptual or clinical framework, procedures, and
analyses to be used to accomplish the specific aims.
Literature Cited – this section does not count against the 5-page limit, but please confine the references to relevant
and current literature.
It is important to relate the Research Plan to your career goals. Although applicants are expected to write the Research
Plan, the primary Mentor should review a draft of the plan and discuss it in detail with the applicant. Career Development
Award applications do not require the extensive detail usually incorporated into standard research grant applications, but a
fundamentally sound plan and methods should be provided.
Section 7. NIH Biographical Sketch. The Biographical Sketch in the standard NIH format, with bibliography and
research support sections, may not exceed four pages. Please see the instructions on the NIH website
(http://grants1.nih.gov/grants/funding/phs398/phs398.html) for detailed instructions, examples, and forms.
Section 8. Division Chief or Program Director Letter(s) of Support. In a letter that is included with your submitted
application, your Division Chief or Program Director must attest to his/her/their support of the application. Depending upon the
rank and department affiliation of the applicant, this letter might reasonably be co-signed by more than one supervisor or chief.
Letters in support of Assistant Professor applicants must be signed by the Division Chief. Letters in support of Fellow
applicants must be signed by the training program director.
The following points must be included:
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75% protected time will be guaranteed for the duration of the award
Any service duties will only be in fields related to non-malignant or malignant blood diseases. In particular, the
applicant will not be assigned to solid tumor, cardiology or stroke clinics.
What is the candidate’s potential for future leadership in non-malignant hematology research?
Section 9. Letters of Reference. Request two additional letters of reference, including at least one from a faculty member
(at Washington University or elsewhere) with whom you have worked in some significant capacity. Provide each of your
references with a copy of the Reference Letter Guidelines, which can be downloaded from the program website
http://hemescholars.im.wustl.edu/apply.html). These confidential letters should be sent directly to the program office. Letters
must arrive by the due dates.
Section 10. Mentors and Letters of Support. Each successful K12 scholar applicant will have two mentors for his/her
training period, selected from the K12 Program Faculty (http://hemescholars.im.wustl.edu/aboutus.html). The candidate may
propose mentors that are not on the current roster, subject to approval by the Advisory Committee. Both proposed mentors
should provide a letter of support, indicating their willingness to:
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Meet frequently with the Scholar to review research progress and discuss future plans;
Give formal feedback at least twice a year;
Provide assistance with writing meeting abstracts, manuscripts, and grants;
Promote opportunities for collaboration, networking, and advancement through participation in professional societies,
meeting attendance, writing of invited articles, and reviewing manuscripts in their field;
Attend program-related seminars and retreat
Attend the annual grantees’ meeting at NIH
In addition, the primary mentor should assist in the writing of the Research Plan, as described above. Both mentors will
receive 5% salary support unless this is precluded by their own employment status (for example, HHMI investigators may be
so precluded).
Provide both candidate mentors with a copy of the Mentor Letter of Support Guidelines, which can be downloaded from
the program website (http://hemescholars.im.wustl.edu/apply.html). These confidential letters should be sent directly to the
program office and must arrive by the application due date.
Washington University K12 Heme Scholars in Non-Malignant Hematology
http://hemescholars.im.wustl.edu; tel (314) 362-9029; fax (314) 454-3012
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