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  1. 2023 Single Application (MSSRPs)

  2. Please complete and submit this online application. If you have questions, contact the Medical Student Summer Research Programs at physci@uab.edu or 934-4092.

     

  3. Choose the program(s) you are applying for. You may apply to more than one.

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  14. Choose the 2023 appointment period you are applying for:(*)
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  15. Legal First Name(*)
    Please type your legal first name.
  16. Legal Middle Name
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  17. Legal Last Name(*)
    Please type your legal last name
  18. Preferred Name(*)
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  19. Current Street Address(*)
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  20. City(*)
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  21. State(*)
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  22. Zip Code(*)
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  23. Email Address (please type, do not copy and paste)(*)
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  24. Secondary Email (other than your school email)(*)
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  25. Telephone Number(*)
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  26. Citizenship(*)
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  27. Gender(*)
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  28. Racial Origin(*)
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  29. Are you Hispanic or Latino?(*)
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  30. Do you have a disability?(*)
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  31. Are you from a disadvantaged background?(*)
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  32. Undergraduate Institution Name(*)
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  33. Institution City/State(*)
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  34. Degree Conferred (e.g. BA, BS, BCh)(*)
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  35. Date completed (MM/DD/YYYY)(*)
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  36. GPA(*)
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  37. Are you in a dual degree program?
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  38. If so which one:
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  39. Previous Research Experience (if any): list year(s), where, mentor's name, short description of project(*)
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  40. Please upload your resume(*)
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  41. Title of your Summer 2023 proposal(*)
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  42. Type of Research(*)
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    *Basic Research generates new ideas, principles, and theories, which forms the basis of progress and development in different fields.
    *Clinical Research studies the safety and effectiveness (efficacy) of medications, devices, diagnostic products and treatment regimens intended for human use.
    *Translational Research applies discoveries generated during research in the laboratory, and in preclinical studies, to the development of trials and studies in humans and enhances the adoption of best practices in the community.
    *Educational Research evaluates different aspects of education.
    *Chart Review Research includes pre-recorded, patient-centered data used to answer one or more research questions.
    *Community Based Research generates social action and positive social change through the use of multiple knowledge sources and research methods within the community.
    *Public Health/Epidemiology Research studies the health in populations to understand the causes and patterns of health and illness.
    *Outcomes Research studies the end results (outcomes) of the structure and processes of the health care system on the health and well-being of patients and populations.

  43. If other research, please specify
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  44. Please upload your project proposal. (written in collaboration with mentor(*)
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    Project Proposal (3 to 5 pages): Research Interests and Career Goals (1 page), Research Project Description (1-3 pages includes Introduction/Background, Project Objectives and Hypothesis, and Methods/Approach) and Literature Cited (3-10 relevant papers).

  45. Mentor's name(*)
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  46. Mentor's email address (please type, do not copy and paste)(*)
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  47. Mentor's phone number(*)
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  48. Mentor's Department(*)
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  49. Mentor Division (if your mentor is in the Department of Medicine, Surgery or Pediatrics, please indicate your Mentor's division)
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  50. Does this research involve animals?(*)
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  51. If yes, list the IACUC protocol number or state when it will be approved.
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  52. Does this research involve human subjects?(*)
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  53. If yes, list the IRB protocol number or state when it will be approved.
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  54. IF YOU ARE APPLYING FOR THE HEERSINK SOM MSSRPs, please read and certify below. 

    Medical Student Summer Research Programs Agreement: STUDENT

    1. I am a student in good academic standing

    2. I am not currently enrolled in a program leading to a Master’s or PhD degree in biomedical research.

    3. I understand that my MSSRP project must be at least 56 sequential days (8 weeks) long. Any exceptions must have prior approval, in writing, from the appropriate MSSRP Director of the program in which I have committed to.

    4. I understand that if I receive MSSRP funding, I may not accept any other summer funding from the University of Alabama at Birmingham or other sources during the time of my MSSRP experience without the prior approval, in writing, from the Associate Director of the Physician Scientist Development Office. Noncompliance will result in revocation of my MSSRP award and if needed, disciplinary action.

    5. MSSRP is a fulltime commitment, during which I may not accept any type of employment, significant additional volunteer commitments, take vacation, or enroll in classes/coursework.

    6. If I need to obtain IRB or IACUC approval for my project, I understand that I must complete the training and approval process by May 1, 2023, or my funding will not be activated.

    7. I will attend/complete all summer seminars/training designated by my program and any additional summer activities pertaining to my research suggested by my mentor.

    8. If I am selected to receive funding from MSSRP, I agree to present my findings (negative or positive) at the UAB Medical Student Research Day (MSRD) (Fall 2023). My mentor and I also understand that one of our goals is to have the results of my summer research included in a subsequent publication from my mentor’s lab with the acknowledgement of the student contribution as co-author.

    9. If I am selected to participate in this program, I agree to return questionnaires concerning the progress of my career that will be sent to me over the next few years, and I agree to provide change of address notification to the MSSRP as necessary.

    10. I independently wrote this MSSRP research proposal.

  55. I certify that I have read and agree with the MSSRP Agreement above.(*)
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  57. Thanks! You will receive a confirmation email.
  58. (*)
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