ITHS TL1 Predoctoral Multidisciplinary Clinical Research Training Application

Use this application for both the Summer and Year-Long TL1 Predoctoral Multidisciplinary Clinical Research Training program.

Receipt deadline:

  • Year-long program: January 15, 2010
  • Summer program: March 1, 2010

Please read the instructions very carefully before completing.  You will be asked to complete a packet of supplemental information, including a research proposal, that must be signed by you and your mentor.  This can either be uploaded to the online application here, or sent via campus mail to:

ITHS TL1 Multidisciplinary Predoctoral Clinical Research Training Program
Box 358051
815 Mercer Street
Seattle, WA 98109-4714

It must be RECEIVED by the receipt deadline mentioned above.

Name and contact information
Non-discrimination/Disability Access Policy

University of Washington reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations. The University of Washington is committed to providing access, equal opportunity and reasonable accommodation in its services, programs, activities, education and employment for individuals with disabilities.
Optional Diversity Information. Consistent with our goal of enhancing the intellectual and social enrichment of the University community, the University of Washington actively seeks and welcomes applicants from diverse backgrounds. We are asked to maintain gender, ethnicity and disadvantage information for federal grants and other statistical purposes. Therefore, we would appreciate information about:

Select all that apply.

Current program

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Prior education

Format: mm/dd/yyyy to mm/dd/yyyy: Funding source
Funding sources: National Institutes of Health, National Science Foundation, Department of Education, American Cancer Society, American Heart Association, Centers for Disease Control and Prevention,
Department of Defense, etc.

Mentor/preceptor information
Project information

Format: mm/dd/yyyy to mm/dd/yyyy

Not to exceed 53 characters.

Please upload your completed Supplemental Information and Signatures packet in PDF format.  If you are unable to submit this online, please print it out, obtain necessary signatures, and send the application to:
The TL1 Program Application c/o Patrick Gibbs
UW Box 358051

Last modified: December 14, 2009