2024 Application Question Title * 1. Biographical Information Full Name: Credentials: Position Title: Institution: Question Title * 2. Please Upload Your CV: PDF file types only. Choose File Choose File No file chosen Remove File Please Upload Your CV: Question Title * 3. Personal Statement Submit a one-page essay to the committee that explains why you should be considered for the Jacobson Promising Investigator Award and describes the importance of your past and current research. Your personal statement must not exceed one page, written in Times New Roman, 12 pt. font, 1 in margins. PDF file types only. Choose File Choose File No file chosen Remove File Submit a one-page essay to the committee that explains why you should be considered for the Jacobson Promising Investigator Award and describes the importance of your past and current research. Your personal statement must not exceed one page, written in Times New Roman, 12 pt. font, 1 in margins. Question Title * 4. Are you a Fellow or an Associate Fellow of the American College of Surgeons? Yes No ACS ID: Question Title * 5. Are you board-certified in a surgical specialty? Yes No Surgical Specialty Question Title * 6. Have you completed surgical training, including fellowship, in the last six years? Yes No Other (please specify): Question Title * 7. Do you hold a faculty appointment at a research-based academic medical center? Yes No Institution: Question Title * 8. Do you hold a military service position? Yes No Branch: Question Title * 9. Have you received peer-reviewed funding such as a K-series award from the National Institutes of Health (NIH), Veterans Administration, National Science Foundation, or U.S. Department of Defense merit review to support your research?Please Note: Surgeon-scientists who are well established (for example, recipients of NIH R01 grants or equivalent grants from other agencies) are NOT eligible. Yes No Award Recieved From: Question Title * 10. Are you a well-established surgeon-scientist who has received NIH R01 and Veterans Affairs Merit grants, or equivalent grants from other agencies? Yes No Award Name Question Title * 11. Do you have ongoing Research Support? Yes No Example:Date:07/01/2007-ongoingK08HS017765 Agency for Healthcare Research and Quality (AHRQ) Composite measures of surgical performance Role: PI Award amount: $150,000 The candidate proposes to develop composite measures of surgical morbidity that overcome many of the limitations of existing approaches. This proposal will facilitate his development into an independent scientist focused on optimizing surgical quality measurement. Question Title * 12. Selected Number of Peer-reviewed Publications: Question Title * 13. Publications List A maximum of 20 peer-reviewed publications may be included in your list. Publications should begin from the first faculty appointment ONLY. Add least current entry first. Most current entry will appear at the top of the list. PDF file types only. Choose File Choose File No file chosen Remove File A maximum of 20 peer-reviewed publications may be included in your list. Publications should begin from the first faculty appointment ONLY. Add least current entry first. Most current entry will appear at the top of the list. Question Title * 14. Upload thethree most significant publications from your current faculty position. Publication PDF file types only. Choose File Choose File No file chosen Remove File Publication Question Title * 15. Publication PDF file types only. Choose File Choose File No file chosen Remove File Publication Question Title * 16. Publication PDF file types only. Choose File Choose File No file chosen Remove File Publication Question Title * 17. Letters of Recommendation Department Chair PDF file types only. Choose File Choose File No file chosen Remove File Department Chair Question Title * 18. Letter of Recommedation PDF file types only. Choose File Choose File No file chosen Remove File Letter of Recommedation Question Title * 19. Letter of Recommedation PDF file types only. Choose File Choose File No file chosen Remove File Letter of Recommedation Question Title * 20. Optional Letter of Recommendation PDF file types only. Choose File Choose File No file chosen Remove File Optional Letter of Recommendation Question Title * 21. Thank you for applying for the Jacobson Promising Investigator Award. Applications will be reviewed by members of the Surgical Research Committee. A decision will be made by mid-June 2024. Please review all the information you have submitted and make any changes before completion. Once the application is submitted, no additional changes can be made I have read and understood all the requirements and eligibility criteria. Page1 / 1 100% of survey complete. SUBMIT
