First Name
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Last Name
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What is your home campus?
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BL-Bloomington
EV-Evansville
FW-Fort Wayne
IN-Indianapolis
MU-Muncie
NW-Northwest
SB-South Bend
TH-Terre Haute
West Lafayette
Which type of programs do you plan to apply? Check all that applies.
IUSM Programs
National Programs
International Programs
Undecided
If you plan to apply to any National and/or International Programs, please specify. Once you have responded to this, you are done with this survey by scrolling to the bottom and click "save".
Remember to fill out and submit required forms for the desired national/international program(s) by the required deadlines for the program.
Include Area Code
Current School E-mail Address
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Permanent E-mail Address (gmail, yahoo, comcast, etc)
Preferred Method of Communication (select all applicable)
Cell
Email
Any
Gender
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Female
Male
Prefer not to answer
Y-M-D
View equation
Ethnicity
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Hispanic or Latino NOT Hispanic or Latino Unknown / Not Reported
Race (Select all applicable responses)
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American Indian/Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Black or African American
White
More Than One Race
Unknown / Not Reported
Emergency Contact (provide name of person)
For residency declaration, are you consider legally a resident of Indiana?
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Yes No
If you are not a legal resident of INDIANA, provide the state.
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From what institution did you receive your undergraduate degree?
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What was your undergraduate major?
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What was your undergraduate cumulative GPA?
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Do you hold a graduate degree (i.e. MS, PhD, PharmD etc)? NOTE: If you hold a graduate degree, you are NOT ELIGIBLE for the NIH-funded training programs.
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Yes
No
If applicable, from what institution did you receive your graduate degree (MS, MA, PhD etc)?
If applicable, what was your graduate cumulative GPA?
MCAT Score
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What is your general field of interest?
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Have you taken any foundation courses in Research/Statistics/Public Health?
Yes
No
If you have taken any foundation courses i.e. Research, Statistics or Public Health, please provide the following: Course Name, Grade, Year Completed, School Name
Do you have previous Public Health/Clinical Research Experience?
Yes
No
If you have previous Public Health/Clinical Research experience, please describe.
Have you ever worked in a laboratory based research?
Yes
No
If you have worked in a laboratory based research, please describe.
How many cumulative hours did you spend conducting laboratory research prior to matriculation into medical school ? (For example, 18 weeks for 15 hours per week = 270 hours)
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How many cumulative hours did you spend conducting clinical research prior to matriculation into medical school ? (For example, 18 weeks for 15 hours per week = 270 hours)
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Please list any relevant skills you have learned and familiar with (i.e. laboratory techniques, assay, equipment, computer programs, statistical software, other technical).
REQUIRED: CV as a PDF file (PLEASE NAME YOUR FILE AS LN, FN_CV, i.e. Nguyen, Anne_CV)
REQUIRED: One Letter of Reference/Recommendation as a PDF file. The LOR can be uploaded or be emailed to imprs@iupui.edu. (PLEASE NAME YOUR FILE AS LN, FN_LOR (i.e. Nguyen, Anne_LOR)
Additional documents you would like to share with the reviewers.
Are you planning or have applied to the IUSM Scholarly Concentration Program?
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Yes
No
If yes, which concentrations? Check all applicable.
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Biomedical Engineering and Applied Medical Technology
Biomedical Research
Business of Medicine
Care of Hispanic/Latino Patients
Equity, Justice
Genetics
Health Information Technology
Health Integration and Healthy Aging
Health Promotion and Disease Prevention
Human Sexuality and Health
Medical Education
Medical Humanities
Public Health
Quality and Innovation
Religion and Spirituality
Rural Health
Urban Medicine and Health Care Disparities
Which training session do you prefer for IMPRS?
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10-week 12-week (only NIH training opportunities; the 12-week period should not interfere with medical school classes) No preference
Do you plan to apply to more than one track?
Yes
No
Select your top two preferred campus locations to conduct your summer research and scholarly opportunity.
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BL-Bloomington
EV-Evansville
FW-Fort Wayne
IN-Indianapolis
WL-West Lafayette
MU-Muncie
NW-Northwest
SB-South Bend
TH-Terre Haute
From the selected preferred campus, which location is the top choice?
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Which THREE tracks are you most interested to apply for IMPRS 2023? Note, only select your top THREE options.
* must provide value
Laboratory/Translational Research
Clinical Research
Health Research Outcome
Community Health and Education
NIH Short Term Training Programs (NOTE: If you hold a graduate degree, you are NOT ELIGIBLE for the NIH-funded training programs)
From the selected tracks, which is the top choice?
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For the laboratory/translational research track, select TWO scholarly opportunities you would like to be considered?
SRP in Translational and Laboratory Sciences (10-week training)
SRP at IUSM-Bloomington (10-week training)
SRP at IUSM-South Bend (10-week training)
SRP at IUSM-Terre Haute (4 slots available and 10-week training)
SRP at IUSM_Northwest (17 slots available and 10-week training)
Student Research Fellowship Program (SRFP) at IUSM-Muncie (6 slots available and 10-week training)
Cooperative Center of Excellence in Hematology (IU-CCEH) (2 slots available; 10-week training)
From the selected laboratory/translational research tracks, which is the top choice?
* must provide value
For the clinical research track, select the top THREE scholarly opportunity are you most interest in pursuing?
Clinical Research in Emergency Medicine (4 slots available and 10-week training at the Indy campus)
Emergency Medicine Scholars and Leadership Program (EMSLP - 4 slots available and 10-week training at the Indy campus)
Clinical Research in Pediatric Gastroenterology (2 slots available and 10-week training)
Clinical Research in Pediatrics (6 slots available and 10-week training)
Clinical Research in the Department of Surgery (6 slots available and 10-week training)
Clinical Research in the Department of Obstetrics and Gynecology (2-4 slots available and 10-week training)
IU School of Medicine - Evansville Translational Research Internship (6 slots in Evansville; 10-week training)
SRP in Radiology (10 slots available and 10-week training)
Clinical Research in the Department of Otolaryngology - Head & Neck Surgery (6 slots available and 10-week training)
SRP at IUSM_Fort Wayne or SERF (20 slots available and 10-week training)
Urology Summer Experience for Underrepresented Students (2-3 slots)
Pediatric Rheumatology Summer Research for Underrepresented Students (1-2 slots)
Thymic Tumor Research (up to 2 slots; 10-week training)
Addiction Research (1 slot; 10-week training)
Dermatology Research (4-6 slots; 10-week training)
Gastroenterology and Hepatology Research (4 slots at the Indianapolis Campus)
Orthopaedic Research (up to 10 slots)
From the selected clinical research tracks, which is the top choice?
* must provide value
For the community health education track, which scholarly opportunity are you most interest in pursuing?
Community Health Engagement Program (CHeP) (8-10 slots available and 10-week training)
Slemenda Scholars Program (2-4 slots available and 10-week training)
For the NIH Short Term Training track, select TWO scholarly opportunities you would like to be considered? NOTE: Most of the mentors will be at the Indy Campus.
NIH NHLBI-T35: Short-Term Training Program in Biomedical Sciences (32 slots available pending available NIH funding and 12-week training)
NIH NIAID-T32: Immunology and Infectious Diseases Training Program [IIDTP] (4 slots available and 12-week training)
NIH NIAMS-T32: Comprehensive Musculoskeletal Training Program (4 slots available and 12-week training)
NIH NEI-T35: Short-Term Training in Ophthalmology Research for Medical Students (6 slots available and 12-week training)
If you are applying for a Laboratory Research, Clinical Research or Health Research Outcomes, select from the list THREE top areas of research interest you would like to participate. (See complete list on the website in the mentor list https://md.mednet.iu.edu/research/imprs/faculty-mentors/)
* must provide value
Addiction
Allergy/Infectious Disease
Autoimmune Disease
Biochemistry
Biological Imaging
Biomedical Engineering Research
Blood/Hematology
Bone Biology
Cancer Biology
Cardiovascular Disease
Clinical Pharmacology
Community Health Engagement
Dermatology
Developmental Biology
Diabetes
Educational Research
Endocrinology
ENT
Gene Therapy
Genetics
Genomics/Pharmacogenetics/Pharmacogenomics
Gastroenterology/Hepatology
Global Health
Implementation Science
Neuroscience and Psychiatric Disease
Medical Informatics/Bioinformatics
Microbiology/Immunology
Musculoskeletal/Orthopaedic
Ophthalmology
Personalized Medicine
Pediatrics Research
Pediatric Gastroenterology
Pediatric Rheumatology
Pulmonary Diseases
Radiology/Imaging Sciences
Stem Cell Biology
Surgery
Urology
Vascular Biology
Please select which area(s) of interest in the Health Research Outcomes Track. (More than one option can be selected) If you do not have a preference, select "Any".
Regenstrief's Institute
Center for Health Innovation and Implementation Science
Center for Computational Biology and Bioinformatics
Any (No Preference)
Please rank your preferences for the type of Community Health and Engagement Medical Student Internship research project. FIRST CHOICE of Project
Heidi Beidinger, PhD UND Tamara Hannon, MD IUSM Debra Litzelman, MD IUSM Kathi Ridley-Merriweather, MA IUSCC Dennis Savaiano, PhD PU Jennifer Shook
Please rank your preferences for the type of Community Health and Engagement Medical Student Internship research project. SECOND CHOICE of Project
Heidi Beidinger, PhD UND Tamara Hannon, MD IUSM Debra Litzelman, MD IUSM Kathi Ridley-Merriweather, MA IUSCC Dennis Savaiano, PhD PU Jennifer Shook
Please rank your preferences for the type of Community Health and Engagement Medical Student Internship research project. THIRD CHOICE of Project
Heidi Beidinger, PhD UND Tamara Hannon, MD IUSM Debra Litzelman, MD IUSM Kathi Ridley-Merriweather, MA IUSCC Dennis Savaiano, PhD PU Jennifer Shook
Please rank your preferences for the type of Community Health and Engagement Medical Student Internship research project. FOURTH CHOICE of Project
Heidi Beidinger, PhD UND Tamara Hannon, MD IUSM Debra Litzelman, MD IUSM Kathi Ridley-Merriweather, MA IUSCC Dennis Savaiano, PhD PU Jennifer Shook
Please rank your preferences for the type of Community Health and Engagement Medical Student Internship research project. FIFTH CHOICE of Project
Heidi Beidinger, PhD UND Tamara Hannon, MD IUSM Debra Litzelman, MD IUSM Kathi Ridley-Merriweather, MA IUSCC Dennis Savaiano, PhD PU Jennifer Shook
What do you hope to accomplish (what are your goals) during your clinical research experience with Emergency Medicine? How will this impact your long-term aspirations? (300 words)
Note: "The Department of Emergency Medicine opportunity is only available at the Indianapolis campus."
Maximum 300 words.
Why are you interested in Emergency Medicine? What do you hope to learn more about? (300 words)
Note: "The Department of Emergency Medicine opportunity is only available at the Indianapolis campus."
Maximum 300 words.
Please explain your interest in the EMSLP, highlighting your past exposure or reasoning for interest in emergency medicine. What do you hope to learn more about in the field of emergency medicine? Finally, do you have any reservations about choosing emergency medicine as a career? If so, please explain those concerns. Max 400 words
Personal Statement: Explain your goals in pursuing a summer research program. Include your current thoughts about long-term career plans. If you are applying for the SLEMENDA SCHOLAR PROGRAM, be sure to include in why you are interested in global health, why you are applying for the Slemenda Scholars Program, and your long-term career goals.
Provide as much information to the tracks you have selected. Maximum 500 words.
Maximum 500 words.
Please describe any prior research, clinical, observership or experiential experiences that qualify you for your preferred summer program track. Include any previous abstracts or publications. Maximum 200 words.
Maximum 200 words.
Have you already made contact with a research mentor?
Yes
No
If you have met with the faculty mentor, please share with the selection committee any additional information such as the mentor's name, the potential project, plans, interest etc.
If you have not met with the faculty mentor but would like the reviewers to consider matching to specific mentor, please share with the selection committee the names of the faculty mentor.
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