WU-CVM Veterinary Scholars Program Application

WU-CVM Veterinary Scholars Program Application Name: Address: City / State / Zip: Phone Number: Email Address: Student ID:

Funding Mechanism: Program year: (MAF, WU-CVM VSP, Merial)

Are you a: 1st Year Veterinary Student 2nd Year Veterinary Student

If enrolled, I will participate in all FIT lunches and field trips If my travel expenses are supported, I will present a poster at the Merial- NIH Symposium scheduled at the end of the Summer Research Program

List the highest education degree received (BS, MS, etc…) and overall GPA:

Indicate your annual GPA since entering the DVM curriculum:

List the location(s) where your project will take place:

of 5 – 2015 Veterinary Scholars Program Application Application What are your career plans and goals? Government / regulatory agencies Biomedical or clinical research in academia (NIH, USDA, NSF, FDA, CDC) Biomedical Research in Industry Private Practice

Other (list):______Not sure

Statement of goals (limit to ½ page): What do you hope to achieve by enrolling in this program? What impact do you expect this program to have on your career goals?

List the research methodology and the learning objectives expected in your project (please work with your mentor)

of 5 – 2015 Veterinary Scholars Program Application Proposed mentor(s): Project title:

A letter of support from the mentor is attached The letter must discuss the source of funding that will cover consumables and supplies, list any funds available to support student’s stipend, along with a description of the availability of the mentor to work with the trainee during the duration of the program.

A “Student summer research grant application” is attached

A copy of the “Student summer research grant application” has been sent to the Office of Research and Biotechnology (Susan Dominguez)

This “grant application” includes a description of the project that the student will conduct. Instructions to complete the form are available below

OPTIONAL INFORMATION: WesternU is dedicated to promoting diversity in all our programs. To that extent, and if you are comfortable, please indicate below if you are a member of an “underrepresented population in the Veterinary profession”. This information would enhance our ability to secure extramural funding for students enrolled in this program.

“Underrepresented in Veterinary Medicine” is defined as populations of individuals whose advancement in the veterinary medical profession has historically been disproportionately impacted by six specific aspects of diversity (gender, race, ethnicity, geographic, socioeconomic, and educational disadvantage) due to legal, cultural, or social climate impediments.

If yes, explain (optional)

Please Email this form and “Summer Student Research Grant Application” to John R. Greenwood: [email protected]; 909.469.5557

of 5 – 2015 Veterinary Scholars Program Application Student Summer Research Grant Application – Instructions

Names: Please list the name or names of all students who are part of this application. (up to 2 students per application, but only one application per student)

Title of Project: The title of the project should briefly summarize the work being conducted.

Student Investigator: A Student Investigator is a student who is currently enrolled at WesternU for the 2015-2016 academic year, and is limited to first and second year students only. The research plan should be in the student’s own words and not cut and pasted from an NIH grant or any other grant but should deal ONLY with research the student will perform during the course of the Summer.

The student name, Social Security Number, home mailing address, College name, contact phone number, email address, and location of research should be completed. If more than one student is submitting an application as part of a group, please fill out a separate personal information page (page 1) for each student. Each student’s information page must be signed by the supporting faculty member in order to be eligible. Priority will be given to students conducting research at Western University.

Faculty Mentor: The name, degree(s), position title, department, phone, fax, email address of the faculty mentor should be completed. The mentor is required to provide a statement identifying the student’s role in the research. Priority will be given to students with a Western University faculty mentor.

Human/Animal Subjects: Projects involving the use of human or animal subjects must have appropriate approval from the Western University of Health Science’s Institutional Review Board (IRB) and/or Institutional Animal Care and Use Committee (IACUC) respectively. An approved protocol from the IRB and/or IACUC is required prior to the start of the research project and funds are released.

Source of Funding: Research supplies and equipment is not to be funded by the student stipend. Here, please include the funding source of non-stipend expenses related with the research proposal (NIH grant, etc.).

Presentation: It is required that students present the data collected during their summer research at a forum on campus. Students are strongly encouraged to present at an off-campus, professional meeting approved by the student’s mentor (Osteopathic students are encouraged to attend and present their research data at the annual Western Student Medical Research Forum (WSMRF) conference in Carmel, CA). Other programs may require students to present at specific off-campus forums most appropriate for their discipline. Faculty PI’s are encouraged to accompany the student to the off-campus forum.

Non-Technical Summary: Please describe the project in terms which someone from outside your area of research would understand. Please use layman’s terms to describe difficult or ambiguous terminology. This description is meant to serve as a succinct and accurate description of the proposed work when separated from the application. Please limit this abstract to the space provided. Page 4 of 5 – 2015 Veterinary Scholars Program Application Research Plan: There are no specific instructions for the Research Plan, though it should include adequate information for proper evaluation of the project. The research plan should not be cut and pasted from an NIH grant or any other grant but should deal ONLY with research to be conducted by the student during the course of the Summer. It should answer the following questions:

 What do you intend to do (Abstract & Specific Aims)?  Why is the work important (Background and Significance)?  How are you going to do the work (Research Design and Methods)? Please include a timeline for the work.

Appendix: Include an appendix if needed.

Please follow the page limitation.

An electronic copy must be sent to [email protected] with an email copy to your Faculty Mentor. In addition, a signed hard copy must be sent to Susan Dominguez in the office of Research & Biotechnology.

Stipend information: Student stipends are $2,000, distributed in two payments of $1,000 each. (Group support will receive the same stipend amount divided equally among the members of the group e.g. for 2 students, each will receive $1,000 distributed in two equal payments of $500.) From this stipend the student is expected to pay their abstract fee to the meeting they plan to attend. The first payment is made on the first week of July. The second stipend will be disbursed the first week of September and upon receipt of the following by the Research Committee:

 A letter from the mentor on his/her stationery stating that student’s work during the fellowship has been satisfactory  A report from each student describing research related activities  The student will be required to repay intramural grant money received from the Research Committee if the student receives an external grant award for the same funding period.

of 5 – 2015 Veterinary Scholars Program Application