Application for a TRANSFORM K12 Career Development Award
PHASE I
Name:
Columbia E-mail Address:
NIH eRA Commons Username:
(If you don’t have one, please contact your department’s grants administrator to obtain one prior
to submitting the Phase I application.)
Department/Division:
Current Academic Title:
Academic Title as of July 1st:
Title of Research Project:
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Application for a TRANSFORM K12 Career Development Award
Names, Titles, Columbia E-mail Addresses, and NIH eRA Commons Usernames of All
Proposed Mentors:
Name
Academic Title
Email Address
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eRA Commons Username
Application for a TRANSFORM K12 Career Development Award
Applicant’s Gender:
Female
Male
Official Mailing Address:
Ethnicity:
Hispanic or Latino
Non-Hispanic
Race:
American Indian or Alaskan Native
Asian
Black or African-American
Native Hawaiian or Pacific Islander
White
More than One Race
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Application for a TRANSFORM K12 Career Development Award
Abstract of Research Proposal (200 words or less):
Be sure to describe the multidisciplinary and interdisciplinary aspects of your proposal.
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Application for a TRANSFORM K12 Career Development Award
Total Number of Peer-reviewed Publications:
Number of First-authored, Peer-reviewed Publications:
Number of published abstracts:
Salary as of July 1st (include base salary plus A1, but not A2):
Other Research Support (past, current, and pending):
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Application for a TRANSFORM K12 Career Development Award
Proposed Schedule and Rationale for Meetings with K12 Mentors (individually and
together):
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Application for a TRANSFORM K12 Career Development Award
Plan for Didactic Training in Patient Oriented Research
Note that all K12 candidates must have completed a research Master’s degree already, or
simultaneously apply to the Master of Science/Patient Oriented Research (MS/POR) track in the
Department of Biostatistics at the Mailman School of Public Health (see application instructions for
further details). Are you also applying to the MS/POR track?
Yes
No
Describe your plans for additional training, and how these educational activities will further your
career as a clinical/translational scientist. If applying to the MS/POR program, include the
electives you would choose. If you already hold a patient-oriented research Master’s degree,
describe the additional courses you would take as part of the K12 award.
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Application for a TRANSFORM K12 Career Development Award
Personal Statement (no more than 500 words):
Please tell us about your career goals, and why you have chosen to seek additional research
training via the TRANSFORM K12.
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Application for a TRANSFORM K12 Career Development Award
NIH Biosketch:
Please remember to attach/include your 4-page NIH biosketch as part of the Phase I application.
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