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* 1. Please confirm you are an ISOPP member (reminder ISOPP membership has no-fee, if you are not a member please sign up before submitting your application to the mentorship program)

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* 2. What is your full name

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* 3. Enter your place of work

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* 4. What country do you work in?

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* 5. What is you email address?

Please provide details of your project below (if you are not able to answer all the questions, that is absolutely fine, either leave blank for put “not sure”, the answers to the questions are meant to help guide the Research Committee to matching the applicant with the most appropriate mentor).

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* 6. What is the title of the project

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* 7. Background (max 300 words) – Tell us where your project proposal fits with the current literature. How is the project relevant or important to your practice site or patient population. Why is this project needed? You should include any relevant preliminary data here.

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* 8. Aims & objectives (max 200 words)– What are the main question or questions you are seeking to address

Method

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* 9. Are you planning to undertake a single site or a multi-site study?

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* 10. What sort of data analysis do you propose?

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* 11. Do you require statistical support?

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* 12. What is the proposed timeline for the project? Please explicitly state over what time period you anticipate you will collect data.

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* 13. Do you have any other information on how do you plan to collect data? (Max 300 words)

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* 14. Funding – Does your project require external funding. If so, is funding already in place? If not (yet), have you specific funding sources in mind?

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* 15. Ethics & governance – Which ethics and governance approvals are required for your project, and are these already in place? Please include in this any relevant requirements for data management.

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* 16. Dissemination – How do you plan to disseminate the results of your project?

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* 17. Which of the following aspects of the research process do you feel you need support with (can select multiple options).

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* 18. Do you have a preference for a specific mentor or mentors to work with you on this project?

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* 19. Please specify your preferred mentor(s) with reasons for requesting specific mentor(s). For a list of mentors click here: https://www.isopp.org/research-mentor-list

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* 20. Any other information you would like to share with the ISOPP research committee?

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