Select cohort:* must provide value
(Cohort 10) 2022-2023
Current date:* must provide value
Today M-D-Y (M-D-Y)
Choose the primary PRIDE program to which you will apply:* must provide value
Advanced Respiratory Research for Equity (AIRE)
Behavioral and Sleep Medicine (BSM)
Cardiovascular Disease Comorbidities, Genetics, and Epidemiology (CVD-CGE)
Cardiovascular Health-Related Research (CVD)
Future Faculty of Cardiovascular Sciences (FOCUS)
Functional and Translational Genomics of Blood Disorders (FTG)
Impact of Ancestry and Gender On Omics of Lung Diseases (AGOLD)
Obesity Health Disparities (OHD)
Research in Implementation Science for Equity (RISE)
Choose any other PRIDE program(s) in which you are interested. (Check all that apply.) Advanced Respiratory Research for Equity (AIRE)
Behavioral and Sleep Medicine (BSM)
Cardiovascular Disease Comorbidities, Genetics, and Epidemiology (CVD-CGE)
Cardiovascular Health-Related Research (CVD)
Future Faculty of Cardiovascular Sciences (FOCUS)
Functional and Translational Genomics of Blood Disorders (FTG)
Impact of Ancestry and Gender On Omics of Lung Diseases (AGOLD)
Obesity Health Disparities (OHD)
Research in Implementation Science for Equity (RISE)
Courtesy title: Dr. Mr. Mrs. Ms.
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Middle name:
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Home street address (2):
City:* must provide value
State / Territory:List of states' and territories' abbreviations ]* must provide value
Zip code:* must provide value
Cell phone:* must provide value
Home phone:
Do you have a LinkedIn Account?* must provide value
Yes
No
If so, what is your account name?
What is your sex?* must provide value
Male
Female
Citizenship:* must provide value
U.S. Citizen Permanent Resident Other (specify)
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Do you consider yourself Hispanic / Latin(o/a)?* must provide value
Yes
No
Declined
Don't know
Which of the following represent your Hispanic origin or ancestry?* must provide value
Puerto Rican
Dominican (Republic)
Mexican / Mexican American
Cuban / Cuban American
Central / South American
Other Latin American
Other Hispanic or Latin(o/a)
Declined
Don't know
What race do you consider yourself to be? * must provide value
American Indian / Alaska Native
Asian
Black / African American
White
Native Hawaiian / Pacific Islander
Declined
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Which Native Hawaiian and / or Pacific Islander group?* must provide value
Native Hawaiian
Guamanian
Samoan
Other Pacific Islander (specify)
Declined
Don't know
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Which Asian group?* must provide value
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian (specify)
Declined
Don't know
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Do you have a disability?* must provide value
I have disability
I don't have disability
Which disability do you have?* must provide value
Physical
Auditory
Visual
Cognitive
Other (specify)
Declined
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If special accommodations are required, please specify:
Do you come from a disadvantaged background? * must provide value
Yes
No
To qualify as disadvantaged you must meet two or more of the following criteria. (Check all that apply) * must provide value
Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act
Were or currently are in the foster care system, as defined by the Administration for Children and Families
Were eligible for the Federal Free and Reduced Lunch Program for two or more years
Have/had no parents or legal guardians who completed a bachelor's degree
Were or currently are eligible for Federal Pell grants
Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child
Grew up in one of the following areas: a) a U.S. rural area, as designated by the Health Resources and Services Administration (HRSA) Rural Health Grants Eligibility Analyzer or b) a Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas
Justification of disadvantaged status:* must provide value
You may upload a statement on why you qualify for disadvantaged status here:
Institution of PRIMARY faculty appointment:* must provide value
PRIMARY department:* must provide value
What is your PRIMARY faculty rank?* must provide value
Instructor Assistant Professor Associate Professor Full Professor Transitioning Post-Doctoral Trainee Research Scientist Adjunct Professor None of the above
Specify other:* must provide value
WARNING You must have a faculty-level appointment PRIOR TO the start of the Summer Institute Program (June - August; dates vary by program) to be eligible for the PRIDE Programs. Your Department Chair will be asked to provide a letter documenting your appointment.
Will / Do you have a faculty appointment prior to the Summer Institute?* must provide value
Yes
No
Date of PRIMARY faculty appointment:* must provide value
Today M-D-Y (M-D-Y)
Institutional street address (1):* must provide value
Institutional street address (2):
City:* must provide value
State / Territory:List of states' and territories' abbreviations ]
Zip code:* must provide value
Work phone:
Institutional email address:* must provide value
Alternate email address:
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Yes
No
Administrative Asst. name:
Administrative Asst. phone:
Administrative Asst. email address:
Have you ever been supported on a research grant?* must provide value
Yes
No
If Yes, specify funding entity and type of grant:* must provide value
Have you ever been a Principal Investigator (PI) on an NIH-funded grant?NIH definition of Principal Investigator .* must provide value
Yes
No
Grant mechanism:* must provide value
R01
Other R-type Grant (R21, R25, etc.)
Other Program Grant (P30, U01, etc.)
Other Grant Mechanism (specify)
Grant # for R01:* must provide value
Specify other R-type grant mechanism (e.g., R21, R25, etc.):* must provide value
Grant # for other R-type grant mechanism:* must provide value
Specify other program grant mechanism (e.g., P30, U01, etc.):* must provide value
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Are you CURRENTLY funded on a K Award? * must provide value
Yes
No
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Grant #* must provide value
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Start date (yyyy):* must provide value
End date (mm):* must provide value
End date (yyyy):* must provide value
Are you CURRENTLY funded on any other training grant or career development award (R25, T32)? * must provide value
Yes
No
Grant type:* must provide value
Grant #* must provide value
Start date (mm):* must provide value
Start date (yyyy):* must provide value
End date (mm):* must provide value
End date (yyyy):* must provide value
Do you have an NIH grant application CURRENTLY pending? * must provide value
Yes
No
Grant Type:* must provide value
Project start date:* must provide value
Today M-D-Y
Anticipated Notice of Award date:* must provide value
Today M-D-Y
Do you have an eRA Commons username?* must provide value
Yes
No
eRA Commons username:* must provide value
ORCID ID:ORCID ID Requirement * must provide value
Research field - Type of Research: Basic Science
Behavioral
Clinical
Epidemiology
Genetics
Health Disparities
Dissemination and Implementation
Methodology
Statistics
Other (specify)
Specify other:* must provide value
Research field - Topics of Interest:* must provide value
Cardiovascular / Heart
Lung
Blood
Sleep
Other (specify)
Specify other:
This PRIDE Training Program is funded by NHLBI. Your research field must be related to Heart, Lung, Blood or Sleep Disorders.
Please provide a brief description of your current and future research interests, and how this program can facilitate your research study. (Space limit of 5,000 characters)* must provide value
PRIDE will offer an opportunity to compete for Small Research Projects (SRP) acting as pilot grants to generate preliminary data for developing NHLBI grant applications. Please give a brief overview of your research plans to take advantage of this opportunity. Describe how your SRP will incorporate the NHLBI research focus on heart, lung, blood, or sleep disorders. (Space limit of 5,000 characters)* must provide value
Highest degree earned:* must provide value
Medical (e.g., MD, DO, etc.) Nonmedical Doctorate (e.g., PhD, ScD, etc.) Combined MD / PhD Other (specify)
Specify other:* must provide value
Preferred Credentials* must provide value
Year highest degree awarded (yyyy): * must provide value
Please name file as shown below: Examples ... Abraham Lincoln's Biosketch: Attach your Curriculum Vita in pdf form to your application by clicking Upload document at right:* must provide value
If you have a Biosketch (not required) , please upload your most recent version in pdf form by clicking Upload document at right:If you don't have a Biosketch and would like to create one , please use the template for new format found in this NIH link .BIOSTAT-pridecc@email.wustl.edu
Please tell us how you learned about the PRIDE Summer Institute Program?* must provide value
Previous PRIDE or SIPID Scholar Department Chair Advisor Colleague Email Advertisement Brochure Flyer or Poster NHLBI Website Other Website Local Specialty Society Meeting National Specialty Society Meeting Word of Mouth LinkedIn / Facebook Direct Mailing Other
Please describe your referral source in more detail:
Name of previous PRIDE or SIPID Scholar
Two recommendations are required to complete your application: one from your current Department Chair and one from a colleague or mentor. A letter of recommendation and support must be received from your Department Chair that guarantees your full participation in the program, as follows: Name of Department Chair: * must provide value
Title: * must provide value
Institution: * must provide value
Department: * must provide value
Mailing Street address (1): * must provide value
Mailing street address (2)
City: * must provide value
State / Territory:List of states' and territories' abbreviations * must provide value
AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ----- AS FM GU MH MP PW PR VI
Zip code: * must provide value
Phone: * must provide value
Email: * must provide value
Does your Dept. Chair have an Administrative Assistant? * must provide value
Yes No
Administrative Assistant name: * must provide value
Administrative Assistant Phone: * must provide value
Administrative Assistant email address: * must provide value
A representative from the PRIDE Coordinating Center will contact your Department Chair to request a recommendation on your behalf. Note that, although the questions in this section include 'Colleague,' the RISE PRIDE Program requires the recommendation come from a senior Faculty member, NOT a Colleague. Name of Mentor or Colleague:* must provide value
Title of Mentor or Colleague: * must provide value
Institution: * must provide value
Department: * must provide value
Mailing street address (1): * must provide value
Mailing street address (2):
City: * must provide value
State / Territory:List of states' and territories' abbreviations * must provide value
AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ----- AS FM GU MH MP PW PR VI
Zip code: * must provide value
Phone: * must provide value
Email address: * must provide value
Does your mentor / colleague have an administrative assistant? * must provide value
Yes No
Administrative assistant name: * must provide value
Administrative assistant phone: * must provide value
Administrative assistant email address: * must provide value
A representative from the PRIDE Coordinating Center will contact your mentor or colleague to request a recommendation on your behalf. Submission of this form allows the PRIDE CC to contact you for additional information regarding your application and career development.
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