UrogynCREST Application

Name *

Email Address *

Institution *

Institution Address *

Year of Fellowship Completion *

Are you a US citizen or permanent resident? *

Are you an active AUGS member? *

Do you have an MD or DO? *

Do you have (or will you have by March 31, 2022) an appointment as an Assistant Professor? *

Did you complete a fellowship approximately 7 years ago? *

Is your department chair/division director supportive of your participation in the 2-year program? *

Are you committed to a career as a physician-scientist with an interest in research on PFDs? *

Please upload the following required documents:

• NIH-style biosketch. See the template here.
• Individual Development Plan. Up to 2 pages detailing:
  • Candidate’s background: describe past accomplishments and experiences (you do not need to duplicate detailed information included in the biosketch)
  • Career goals and objectives: Include short and long term goals
  • Career development plan: Explain how past, current and planned activities, as well as your proposed research project for this program, will help ensure career progression
• Concept proposal in candidate’s area of interest in pelvic floor disorders (up to 2 pages). This does not need to be fully fleshed out, however, do address the following areas (as appropriate) as best you can:
  • Background
  • Study question
  • Study design
    • Statistical analysis
    • Covariates/confounders
    • Outcomes
    • Comparison/Control
    • Study variables of interest
    • Proposed database
    • Population
• Two letters of support from individuals familiar with the candidate’s research activities
• One letter must be from Chair/Division Director supporting the candidate’s commitment to complete the UrogynCREST program

The other letter can be from a research collaborator and can be from outside of the candidate’s institution