Early Investigator Research Development Program Screening Survey

To apply for the CARRA EI Research Development Program (RDP), please complete the following screening survey:

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* 1. Submitter Information

Name:

Institution:

Email Address:

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* 2. What year did you (or will you) complete fellowship?

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* 3. Upload a draft version of the grant specific aims page (or, if aims page is not yet available, a short abstract of the proposed study)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 4. Upload your CV or NIH biosketch

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 5. Upload the grant RFA, if available

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 6. Provide a web link to the grant RFA, if available

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* 7. What is the deadline for internal review of this grant, per your institution’s guidelines?

Note: Ideally, the RDP applicant would request this service 3-4 months in advance of the deadline, but exceptions can be made on a case-by-case basis.

Date

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* 8. What are your long-term career goals?

Clinician primarily, but participating in collaborative research

Research primarily, independently funded

Other (please specify)

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* 9. What type(s) of research do you plan to conduct during your career? (check all that apply)

Basic science research

Translational research

Clinical research

Other (please specify)

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* 10. What is the highest level of formal research training you have received, if any?

I have not completed certificate or degree programs with formal research training

Certificate in clinical research

Masters in clinical research

Masters in public health

PhD

Other (specify type of training and duration of program in years)

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* 11. Do you have at least one research mentor?

Yes

Unsure