ITHS TL1 Multidisciplinary Pre-doctoral Clinical Research Training Program
Year-long Research Application Packet (Due January 22nd, 2014)
Application instructions:
The applicant must complete and review sections 1-5 and return to the following email address by January 22nd,
2014:
ithsedu@u.washington.edu
Please include the following in the subject line:
2014 TL1 Year-long Research Application Packet
The mentor(s) must be copied when submitting the completed application.
The primary mentor must complete section 6 and return to the following email address by January 27nd, 2014:
ithsedu@u.washington.edu
Please include the following in the subject line:
2014 TL1 Year-long Mentor Statement
1. Student Commitment to Training Period & Report
If accepted into the TL1 Program, I agree to fulfill all NIH training obligations including but not limited to
completing PHS biomedical ethics training and completing and submitting NIH appointment and termination
letters.
Acceptance of funds entails an obligation to submit a report of activities carried out during the funded period. This
report should be in the form of a scientific abstract following the guidelines provided by the ITHS, and it should be
submitted to Robert DeSpain at ithsedu@uw.edu by January 15, 2015.
Approval/Acceptance Signatures
________________________________
Student Applicant
________________________________
Mentor/Preceptor
2. Credits for Courses and Independent Study for Project:
Specific coursework is required of students in the year-long program. Tuition support is provided to each trainee
for these courses. Some credits may be independent study credits offered in the Mentor’s department, with the
Mentor serving as the Course Director for the independent study credits. There is a required quarterly Seminar
designed for the entire TL1 cohort. One additional NIH requirement is the completion of the entire 2014 summer
Biomedical Research Integrity (BRI) Series.
I understand that I will be required to register for 10 credits graduate level each quarter as part of my traineeship
while conducting my Clinical Research project and attend the BRI series.
________________________________
Student Applicant
I agree to serve as Director for the student’s independent study for the Research Project.
________________________________
Mentor/Preceptor
3.
Project Description
Please provide a description of the proposed research project. You should include:
 Summary of proposed project (not to exceed 200 words). Indicate how this project relates to
interdisciplinary clinical research.
 An introduction containing a review of published literature and other observations which serve as the
basis for the project.
 A statement of rationale and research objectives for the project.
 A description of the experimental protocols to be carried out.
 An explanation of how the data will be managed and processed, including statistical analysis where
appropriate.
 A statement of the significance of the work relative to the knowledge in that general area. The proposal
should not be more than a maximum of 5 pages, double-spaced typing (items 2-6 above).
It should include sufficient detail for satisfactory review by the Recruitment and Selection
Committee. Please provide a bibliography with citations for referenced items.
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4.
Budget Information
Will this project require funds for supplies, equipment, local travel, publication costs, xerox, telephone costs,
subject participation payments, or other costs? (Up to $1,600 may be requested). Please itemize and show total
funds requested. Please note that the items/services requested will still need to be approved upon acceptance
into the TL1 program and must be consistent with NIH guidelines on allowable research costs.
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5.
Project Timeline
Complete the table below showing what activities you plan to undertake during each period, beginning Summer
Quarter 2014, and ending at the close of Spring Quarter 2015.
Time Period (Dates Beginning Summer 2014)
Project Activities
# Weeks
6.
Mentor/Preceptor's Statement
The primary mentor must complete section 6 and return to the following email address by January 27nd,
2014:
ithsedu@u.washington.edu
Please include the following in the subject line:
2014 TL1 Year-long Mentor Statement
In the space provided, please provide a description of the following:
 How long and in what capacity have you known the applicant?
 What is the expected clinical/translational learning experience provided to the student, i.e.,
specific learning objectives?
 Please evaluate the student’s potential for a career in clinical/translational research. (If
applicable, indicate you do not know the applicant well enough to provide an answer.)
[enter text here]
Mentor/Preceptor's Assurance:
I take responsibility to assure that the student is provided the clinical/translational opportunity described herein.
________________________________
Mentor/Preceptor
________________________________
Date