Rome Foundation Mentorship Application
This application is for those interested in participating in the Rome Foundation's inaugural Mentorship Program at DDW in Chicago, Illinois this May. By completing this application, you are certifying that you have a need for a mentor, and will be able to provide for your own travel to the event at DDW on Saturday, May 6th, 2017 from 3-6 p.m for a fifteen minute presentation. The deadline for applications is March 18, 2017, with 6 applicants being selected the first week of April.
Email address
Name
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Title
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University or Institution Name
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If you are applying as part of a group, name(s) of your collaborator(s)
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Your Mailing Address
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Phone Number (including country code)
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E-mail Address
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Birthdate
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DD
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Gender
Academic degrees with name(s) of awarding institution(s) and dates received
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If any, medical degrees and certifications, including awarding institutions and dates received
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Briefly explain how participating in this program will benefit you.
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Description of proposed research (please limit to DDW abstract size). Include the following items (a) working title, (b) objective and rationale for the research, (c) proposed experimental procedures and research plan, (d) how you will measure the results
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What stage is your research study in?
Will your research be funded? If so, by who?
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