Global Health Scholarly Activity Project Proposal



Scholarly Activity Project Proposal

General Instructions:

The Global Health Track Scholarly Activity Proposal should be brief, with sufficient detail to provide your mentor/ track director insight into your plans. The use of graphs and lists are permissible and helpful.

Your proposal needs to be reviewed and approved by your mentor prior to submission.

Students may not begin their scholarly activity before they receive approval to start from the Track Director.

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|1. Student Name: |Last: _______________ MI:__________ First: _______________ |

|2. Student ID: | |

|3. SA Block/ Dates: | |

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|4. Faculty Mentor : |Last: _______________ MI:__________ First: _______________ |

|5. Mentor’s Dept. | |

Project Information:

Proposal is for a new project ☐ Proposal to join an existing project☐

|4. Student Affirmation: |

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|[ ] By checking this box, I (the student) indicate that I have discussed the mentor agreement with my mentor and we have agreed to work |

|together. |

|5. SA Project Title (Please use 20 words or less): |

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|6. Project Aim (Please describe what you want to accomplish with your project. Be specific. For research projects you should state your |

|research question and /or hypothesis): |

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|7. Project location (which country and hospital (s) will the research be at)? |

|(Hospital & EMR: If working on a comparative study, PMH/UT credentialing must be completed) |

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|8. Background: Briefly explain why you have chosen this project. |

|How the project fits into a larger area of inquiry /development of value to yourself, &/or the global society? |

|“For research –oriented purpose, you should explain why your question is important and how the knowledge you obtain builds on prior studies, |

|if any.” |

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|9. Hypothesis: Describe how you expect the anticipated outcomes of your project will contribute to the area of injury/development referenced |

|above. |

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|10. Study Design/ Methods: Outline and describe the sequence of activities you will do to complete your project, including the preparation of |

|your final summary (5-10 page paper). |

|“For research-oriented projects, you should describe such items as study design, obtaining IRB approval both locally and onsite, selection of |

|subjects, data collection and analysis”. |

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|11. Ethics committee/ IRB Approval: Please state if your project requires IRB review and/or approval and, if so, at what stage is your |

|submission (approved, submitted or in development). Note: If your project requires approval you will not be able to start until the approval |

|is obtained. |

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|12. Conclusion: Describe what you will produce to synthesize and share project outcomes. |

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|13. Timetable: Describe the general timetable for project activities (i.e., months you have dedicated to work on the project by checking |

|appropriate boxes below) and the timetable of key milestones. |

|2017: |

|☐Jan ☐ Feb ☐ Mar ☐ Apr ☐ May ☐ Jun ☐ Jul ☐ Aug ☐Sep ☐Oct ☐Nov |

|☐Dec |

|2018: |

|☐Jan ☐ Feb ☐ Mar ☐ Apr ☐ May ☐ Jun ☐ Jul ☐ Aug ☐Sep ☐Oct ☐Nov |

|☐Dec |

|Timetable of Key Milestones: |

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|14. Proposed timeline of Goals and Objectives: Deadlines within the SA block that the student and mentor will need to meet: |

|Week 1: complete ethics training |

|Week 10: send final summary draft to mentor |

|Week 12: complete evaluation of program and student |

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|Student’s Initials: ________ Mentor’s Initials: __________ |

|15. Roles and Responsibilities: Describe the expected contributions essential to project completion of individuals involved in your project, |

|including yourself, your mentor, and if applicable, other students and/or members of mentor’s team. |

|“For research-oriented projects, your description should include information about if and how your project dovetails with other projects”. |

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|16. Budget: Please include an estimate of any anticipated expenses associated with your project. |

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During this elective, the mentor and student understand that the student is to spend a full time effort in actively working in the research setting. In order to get credit for this elective, the student will need to submit a final summary of the research done and the mentor and onsite preceptor will need to submit an evaluation of the student’s progress.

|Signatures |

|Student : |Mentor: |

|_____________________________________ |_______________________________________ |

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