University of Pittsburgh | UPMC | Health Sciences at Pitt | School of Medicine



2010 Course in Scientific Management and Leadership

Online Application (Back to leadership course website)

Deadline for Application: DECEMBER 15, 2009

Name and E-mail
First: Middle Initial: Last:
Gender
Ethnicity
Race

E-mail:
Street address 1:
Building:
Room:
City: State: Zip:
Campus phone: -
Cell phone: -
Select Your Highest Degree
Current Position and Titles:
Title 1:
Title 2:
Title 3:
Department:
Division:
School:
Nominated by (including title & affiliation):
(Must be nominated by Department Chair, Division Chief, Center/Institute Director, or Dean)
First: Middle Initial: Last:
Title:
Department:

I will commit to attending all of the planned sessions:
Are you a:
Please specify other:
If you are a postdoctoral or clinical fellow:
How many years have you had your current position?
Have you started applying for faculty positions?
Do you anticipate starting a faculty position within the next 12 months?
Do you supervise any students, technicians, or research staff in your current position?
If you are a faculty member:
How many years have you had your current position?
Are you currently the principal person responsible for managing your laboratory or research program?
How many people are you responsible for supervising in your laboratory or research environment?

Fellows:

Graduate & undergrad. students:

Research staff:
Please provide three reasons why you should be selected to participate in this course (limit 200 words).
Please attach your letter of nomination. You may either:
  1. Upload the letter (pdf or doc only)


  2. Paste the letter below

Course acceptance will be acknowledged by email by January 15, 2010.
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