ISOPP Research committee mentorship programme Question Title * 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) Yes Question Title * 2. What is your full name Question Title * 3. Enter your place of work Question Title * 4. What country do you work in? Afghanistan Albania Algeria Andorra Angola Antigua & Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia & Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic DR Congo Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea North Macedonia Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts & Nevis Saint Lucia Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka St. Vincent & Grenadines State of Palestine Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe Other (please specify) Question Title * 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). Question Title * 6. What is the title of the project Question Title * 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. Question Title * 8. Aims & objectives (max 200 words)– What are the main question or questions you are seeking to address Method Question Title * 9. Are you planning to undertake a single site or a multi-site study? Single site Multi-site -same country Multi-site - multi country Other (please specify) Question Title * 10. What sort of data analysis do you propose? Question Title * 11. Do you require statistical support? Yes No Not sure Other (please specify) Question Title * 12. What is the proposed timeline for the project? Please explicitly state over what time period you anticipate you will collect data. Question Title * 13. Do you have any other information on how do you plan to collect data? (Max 300 words) Question Title * 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? Question Title * 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. Question Title * 16. Dissemination – How do you plan to disseminate the results of your project? Question Title * 17. Which of the following aspects of the research process do you feel you need support with (can select multiple options). Project design (defining aims/objectives, data collection etc.) Finding potential collaborators Grant application / funding streams Ethical approvals Data analysis Writing up project / preparing manuscript for publication Other (please specify) Question Title * 18. Do you have a preference for a specific mentor or mentors to work with you on this project? Yes No Question Title * 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 Question Title * 20. Any other information you would like to share with the ISOPP research committee? After you have submitted your application, it will be initially assessed by the Chair of the ISOPP research committee. If deemed appropriate for review, the Chair will send the application to at least two members of the Mentorship Network for review with a suggested 3-4 week turnaround time. Projects will be discussed with the Chair and/or a member of the research committee to collate the feedback, suggestions, and plan for ongoing mentorship/support, if appropriate. The Chair will communicate all feedback to research project leads. The communication will include: Initial e-mail with summary of feedback, with follow-up half-hour online meeting as required Further communication as needed Assignment of 1:1 mentor(s) as needed The requirement to acknowledge ISOPP in any presentation/publication of the research Done