TICR

UCSF Roadmap K12
Multidisciplinary Clinical Research Scholars Program
LETTER OF INTENT
(revised on 8/17/2007)

You must submit this letter of intent by noon on November 12, 2007. You must also e-mail to adeneen@psg.ucsf.edu by noon on November 12, 2007 your CV formatted following UCSF guidelines. We recognize that this preliminary plan and your final application may differ, and will use only the latter for our final funding decision. Note that your answers to the questions below are limited to 800 characters for questions 1,3,4 and 5 and 1200 characters for question 2.

Identity
Last Name First Name Graduate Degree(s)
Institution School(e.g. Medicine) Yrs since degree
Department Position Yrs. in Position
Email address Telephone # UCSF Box #(if applicable)
Proposed Lead Mentor Department Discipline
Proposed Co-Mentor Department Discipline (different from above)
Proposed Co-Mentor Department Discipline (different from above)

Gender
M   F

Race/Ethnicity. Are you Hispanic (or Latino)?
Yes   No   Intentionally withheld

What is your racial background? Check all that apply
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Asian 		Black or Aftrican American
White
Intentionally withheld

Track Record
Summarize your area of expertise and prior training, past and current research activities, and the role you played (800 character limit).

Research Plan
Present an abstract of the research you plan, noting specific aims, significance, and design components (study subjects, variables, sample size, etc.) (1200 character limit).

Training Plan
Summarize the relevance and multidisciplinary complementarity of your intended mentors and indicate your plans for further training and expanding your professional expertise (800 character limit).

Resources
Summarize the resources provided by your home department and the suitability of the available clinical, administrative, and laboratory infrastructure (800 character limit).

Career Potential
Describe your career goals and rough timetable, and how these will be amplified by the Roadmap K12 program (800 character limit).