<p> Application for T32 Trainee in Movement Disorders</p><p>Due date: June 19, 2017 Send items 1-4 as a single collated PDF Item 5 (letter of rec) can be sent separately</p><p>1. Application Form, which also includes the following: </p><p> Description of your research interests & career goals, and how participation in this training grant may help you meet them (no more than 1-2 pages max, single spaced)</p><p> Brief 1-2 page research proposal with specific aims, hypotheses and methods. Indicate why important (i.e., significance). Again, single spaced.</p><p>2. Curricum Vita </p><p>3. CV Supplement</p><p>4. Graduate Coursework Transcript</p><p>5. Letter of Recommendation from your primary mentor and one other UF faculty, that includes comments on the following:</p><p> o Student’s past productivity and plan for maximizing future productivity</p><p> o Expected career trajectory</p><p> o Strengths and Weaknesses</p><p>Send copy of application to both Co-directors:</p><p>Dawn Bowers, Ph.D. [email protected] David Vaillancourt, Ph.D. [email protected]</p><p>- 1 of 3 - Application for University of Florida T32 Training Program in Movement Disorders Last Name First Name Middle Name</p><p>Permanent Address - Street City State Zip</p><p>Country Telephone: (Business) Telephone: (Home) Email Address: ( ) ( ) U.S. Citizen: IF NOT U.S. CITIZEN: Yes No Permanent U.S. Resident: U.S. Non-Citizen National: Yes No Yes No Equal Opportunity/Affirmative Action We are required by NIH to collect the following information for reporting purposes. The University of Florida is committed to a policy of equal opportunity and affirmative action in the appointment process. We welcome and encourage applications from underrepresented minorities, women, and persons with disabilities.</p><p>Gender: □ Male □ Female</p><p>Race/Ethnicity (check all that apply)</p><p>□ American Indian □ Native Hawaiian or Pacific Islander □ Asian □ Hispanic or Latino/a □ Black/African-American </p><p>□ White (Non-Hispanic) □ Intentionally Withheld</p><p>Emergency Contact:</p><p>Name/Telephone # Address Relationship</p><p>Colleges, Graduate and Professional Schools Attended:</p><p>Degree or Expected Institution Name City & State Dates of Attendance Date Major</p><p> to</p><p> to</p><p> to</p><p>Previous Fellowships Supported by USPHS:</p><p>Location Program Title Dates</p><p>Were you ever required to leave any college or professional school (e.g., suspension or dismissal) or denied readmission for any reason? If “yes” explain fully. YOU MUST ANSWER THIS QUESTION. Yes No (Attach additional sheet if necessary)</p><p>Have you visited our website? Yes  No </p><p>How did you hear about the Training Program?______Years of experience with SAS______SPSS______STATA______OTHER______</p><p>- 2 of 3 - Please list classes you have had in statistics.</p><p>Current Faculty Mentor: ______Home Department ______</p><p>Year in Doctoral Program ______Masters degree? Yes No</p><p>Current Research interest: ______</p><p>To be considered as an Interdisciplinary Trainee, your committee must include at least one other faculty with movement disorder interests whose area of expertise falls outside your primary area: The 3 primary areas are:</p><p> a) Human motor and cognitive science b) Translational neuroscience and physiology c) Molecular biology and animal models</p><p>Specific approaches within these themes can range from genetics to molecular to neuroimaging to neurorestoration to behavioral or clinical trials, but the central focus must be movement disorders. </p><p>Research Experience Location Topic Principal Investigator Your Role</p><p>- 3 of 3 - Please append the following:</p><p>1. A description of your research interests & career goals, and how participation in this training grant may help you meet them (no more than 1-2 pages max); Single spaced</p><p>2. Brief 1-2 page research proposal with specific aims, hypotheses and methods. Indicate why important (i.e., significance) Single spaced</p><p>CERTIFICATE STATEMENT AND SIGNATURE</p><p>I certify that the information submitted in this application and associated materials is complete and correct to the best of my knowledge.</p><p>______Signature Date</p><p>SUBMIT</p><p> This application  1-2 page statement of career and training goals (see above)  1-2 page research proposal with specific aims/hypotheses (see above)  Curriculum Vitae  CV supplement  Graduate Coursework Transcript  Letter of recommendation from your primary mentor</p><p>Collate all above into a single PDF (except letter of recommendation) Deadline: June 19, 2017</p><p>Send to both Co-directors:</p><p>Dr. Dawn Bowers, [email protected]</p><p>Dr. David Vaillancourt [email protected]</p><p>- 4 of 3 -</p>