Umfmedical Student Research Grant Application

Umfmedical Student Research Grant Application

UMFMedical Student Research Grant Application

  1. This is an application for (check one):
    Summer Research Grant (MS1)
    Research Grant (MS 3&4)
  2. Name:
  3. University email:
  4. Class Year:
  5. Current Address
    Street Address:
    City: State: ZIP:
  6. Project Title:
  7. Project Dates: From to
  8. Research Category:
    Basic science bench research
    Clinical research involving direct patient observation
    Clinical lab research
    Clinical research involving patient health databases

Community-based research involving data acquisition by the student

  1. Research area (e.g., heart cancer):
  2. Faculty Project Supervisor
    Name:
    Email:
    Department:
    Campus Mailing Address:
    Campus Phone:
  3. Does the project have a relationship to heart or cardiovascular research?
    Yes No
  4. If yes to the above question, will the project supervisor apply for a Medical School Supplementary Research Award?
    Yes No
  5. Description of Research Design: Attach a separate protocol detailing project goals, hypothesis to be tested, steps in planned procedure, materials and methods to be used, description of what the applicant will be doing and how the applicant will benefit, etc. Limit your statement to a maximum of two pages; applications with statements in excess of two pages will be returned. A sample protocol is included in the Policies and Guidelines at
  6. If human subjects or materials, animal subjects, or biohazardous materials are to be used, your project supervisor must obtain, or must have obtained, approval from the appropriate University of Minnesota Committee (see below). Final approval of any grant is contingent on evidence of such approval (see U of MN Board of Regents Policy Statement of 6/3/73).
  • Human subjects: Institutional Review Board (IRB),
  • Animal subjects: The Animal Research Compliance division of the Office of Regulatory Affairs (ORA),
  • Biohazardous materials: Institutional Biosafety Committee (IBC),

Check one:

Applicant certifies that no human subjects or materials, animal subjects, or biohazardous materials are to be used.

Approval pending, applied for on (date).

Approval obtained on (date). Project number:

Submission Instructions

Submit your application materialselectronically or in person to:

Austin Calhoun, PhD
Chief of Staff
Office of Medical Education

(612) 624-9473

The following signatures are required:

Certification of Academic Standing by Medical School DeanDate

Signature of Project Supervisor *Date

Signature of ApplicantDate

*Project supervisor must attach a signed letter, which includes:

  1. A commentary on the proposal that the student has written and the student’s role in the project.
  2. An endorsement of the candidate.
  3. A request, if relevant, for a Medical School Supplemental Research Award to support the costs of the student’s research.
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