MSRP Student Proposal Form PrerequisiteSuccessful completion of first year and submission of final project proposal application due by April 15, 2020 REQUIREMENTSContact the faculty mentors to discuss project background, specific aims, and role of the medical student. • After selecting an R&D project and faculty mentor, the medical student and mentor will submit a brief R&D pre-proposal. • Submit a final R&D proposal. • Submit a final report of the 10-week R&D activity. • Present a poster on the R&D activity at Medical Student Celebration of Research Poster Day. • Ensure addition to mentor’s IRB or IACUC (even if participating in an external MSRP projects, including international projects) and work with UF mentor to ensure UF’s IRB/IACUC office approves the research too, otherwise research may be invalid. ALL REQUIRED TRAINING'S MUST BE COMPLETED BEFORE RESEARCH COMMENCES Student InformationName* First Last UF Email Address*Local Summer Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Student UFID Number*Faculty Mentor InformationFaculty Mentor's Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Faculty email*Faculty UFIDFaculty Department*Research ApprovalIRB-01*Approval neededAlready approved/student will be addedAlready approved/ student already addedNot applicable to this projectIRB-02*Approval neededAlready approved/student will be addedAlready approved/ student already addedNot applicable to this projectIACUC*Approval neededAlready approved/student will be addedAlready approved/ student already addedNot applicable to this projectIf your project does not require IRB or IACUC please explain below (literature review, quality improvement, etc.)IRB-03 mandatory training*Does this project contain an INTERNATIONAL component?*YesNoIf yes please upload your pre-departure training, CISI and travel registration screenshotsProject InformationGeneral Title of Project:*Background and significance*Please describe in 2-3 paragraphsHypothesis and rationale*1 paragraphSpecific Aims*1 paragraphMethods and materials*2-3 paragraphsPlan for data analysis*1-2 paragraphsRole of Medical Student*1 paragraphReferences*5-10 citations If you project contains an international component please see additional requirements
