Download:
pdf |
pdfDirec&on
to
Trainees
for
CareerTrac
Data
Expansion
Please
take
10-‐15
minutes
to
review
this
spreadsheet
and
update
or
provide
any
new
informa:on
that
will
help
us
demonstrate
the
value
of
the
T32
training
program.
If
you
only
have
a
limited
amount
of
:me
to
provide
new
informa:on,
we
ask
that
you
focus
on
providing
informa:on
about
any
employment
you
have
had
since
leaving
the
training
program
(see
Tab7
Employment
Tab)
and
on
any
career
highlights
(Tabs
6-‐15)
that
you
would
like
to
report
(See
Tab
6,
Career
Higlights).
Making
Changes
to
Data
Imported
from
IMPAC
II
(Fields
shaded
gray
)
If
a
field
is
shaded
gray,
that
informa:on
is
imported
from
the
NIH
IMPAC
II
system,
via
either
the
Commons
profile
or
the
xTrain
module.
If
you
need
to
make
changes
to
informa:on
in
a
gray
field,
you
must
do
so
in
IMPAC
II
not
CareerTrac.
See
the
eRA
Commons
user
guide
for
step
by
step
instruc:ons
to
enter
or
edit
your
personal
profile
informa:on.
The
link
is
listed
below
http://era.nih.gov/files/personal_profile_userguide.pdf
Returning
the
Spreadsheet
Please
return
the
form
to
the
Principal
Inves:gator
for
the
UNIVERSITY
OF
MICHIGAN
T32
program
by
09/20/2015.
PI
email
address:
johndoe@umich.edu
Respondent
Burden
Statement
Public
repor:ng
burden
for
this
collec:on
of
informa:on
is
es:mated
to
average
30
minutes
per
response,
including
the
:me
for
reviewing
instruc:ons,
gathering
and
maintaining
the
data
needed,
and
comple:ng
and
reviewing
the
collec:on
of
informa:on.
An
agency
may
not
conduct
or
sponsor,
and
a
person
is
not
required
to
respond
to,
a
collec:on
of
informa:on
unless
it
displays
a
currently
valid
OMB
control
number.
Send
comments
regarding
this
burden
es:mate
or
any
other
aspect
of
this
collec:on
of
informa:on,
including
sugges:ons
for
reducing
this
burden,
to:
NIH
Project
Clearance
Branch
6705
Rockledge
Drive,
MSC
7974
Bethesda,
MD
20892-‐7974
ATTN:
PRA
0925-‐0568
Do
not
return
the
completed
form
to
this
address.
This
ques&onnaire
includes
the
following
sec&ons:
Personal Information------------------------------------------Tab 2
This
sec:on
contains
ques:ons
regarding
your
personal
informa:on,
including
name
and
email
address.
Contact Information-------------------------------------------Tab 3
This
sec:on
contains
ques:ons
regarding
your
mailing
address
and
phone
number.
Pre-Training Information-------------------------------------Tab 4
This
sec:on
contains
ques:ons
regarding
your
professional
and
educa:onal
history
before
your
T32
funding
/
training
In-Training Experience -----------------------------------------Tab 5
This
sec:on
contains
ques:ons
regarding
your
T32-‐funded
training
experience.
It
also
contains
ques:ons
regarding
the
degree
or
cer:ficate
earned
through
your
T32-‐funded
training,
the
start
and
end
date
of
your
funding
period,
and
mentor
data
etc…
Accomplishments-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐Tab
6
-‐
15
This
sec:on
contains
ques:ons
regarding
your
personal
achievements
that
can
be
acributed
to
your
T32-‐funded
training.
> Career Highlights------------------------------------------------------Tab 6
> Employment------------------------------------------------------------Tab 7
> Fellowship---------------------------------------------------------------Tab 8
> Honor and Awards----------------------------------------------------Tab 9
> New Competitive Funding------------------------------------------Tab 10
> Post-Training Education---------------------------------------------Tab 11
> Posters at Scientific Meeting---------------------------------------Tab 12
> Product or Policy Development-----------------------------------Tab 13
> Publications-------------------------------------------------------------Tab 14
> Students------------------------------------------------------------------Tab 15
Personal Information
First Name:
Bruce
Middle Name:
Last Name :
Wayne
Suffix (ie. Jr., Sr.,
I.,):
Address Line 1:
Address Line 2:
1234 MAPLE HILL EAST
WEST BLOOMFIELD, MI 48323
Address Line 3:
Address Line 4:
Address Line 5:
City:
State:
Country:
Postal Code:
Phone Number:
Fax Number:
Email Address:
Training Status:
Post-Training
Alternative Contact Information
Alternative Address
Line 1:
1234 Mountain Lane
Alternative Address
Line 2:
Alternative Address
Line 3:
Alternative Contact
City:
Gotham
Alternative Contact
State:
NY
Alternative Contact
Country:
UNITED STATES
Alternative Contact
Postal Code:
1234
Phone Number:
Cell Phone:
Alternate Email
Address:
555-555-5555
555-555-5555
brucewayne@wayneenterprice.com
Pre-Training Information
Previous Position
Position
Position Other
Employee
Title of this professional position
Test
Institution or Company where this last Location of Institution
professional position was held
or Company
Test Inc.
Prior Academic Degrees
Degrees held before start of training (You can enter
more than one degree, as applicable)
Country of the institution that granted the
degree (please no acronyms)
Institution that granted the degree
(please no acronyms)
Year the degree was awarded (YYYY)
UNITED STATES
In-Training Education
(There are 3 sections on this tab. Please scroll down to make sure you review all 3.)
Date Training Began (may be different Date Training Ended (may be
Trainees Research Project Title (e.g., name from when you entered Graduate School or different from when you entered
of Master’s Thesis or Post-Doctoral Project)
Test Test Test Test Test Test Test
Post-Doctoral Appointment) (MM/DD/
YYYY)
09/01/1996
Scientific Technical Emphasis
AIR QUALITY - INDOOR (COOKSTOVES)
AIR QUALITY - OUTDOOR
ASBESTOS
ASTHMA
BEHAVIORAL/SOCIAL
AUTISM
Graduate School or Post-Doctoral
Appointment) (MM/DD/YYYY)
12/31/1996
Degree Level (Pre-Doc, Post-Doc)
PRE-DOC
NIH Field of Training
3240 - Toxicology
Sources of Support
ABMRF/THE FOUNDATION FOR ALCOHOL RESEARCH
ALZHEIMER'S ASSOCIATION
AMERICAN ACADEMY OF ALLERGY, ASTHMA & IMMUNOLOGY
Research Training Mentor
Mentor’s First Name (required)
Mentor’s Last Name (required)
Country of Institution
(required; please do not use
acronyms)
Institution Name (required; please do not use
Mentor’s Department (required)
acronyms)
JOHN
DOE
UNITED STATES
A. I. DUPONT CHILDREN'S HOSPITAL
TEST
RUDY
RICHARDSON
UNITED STATES
UNIVERSITY OF MICHIGAN
ENVIRONMENTAL HEALTH SCIENCES
MICKEY
MOUSE
UNITED STATES
ABBVIE BIORESEARCH CENTER
ABCD DEPT
Start Year of Mentoring (please enter
date as YYYY)
End Year of
Mentoring (please
1996
enter date as YYYY)
1996
2008
2008
In-Training Education
(Please list all the degrees, certificates, or training completed while supported by the ES training program.)
Degree or Nature of Training (required; You
can enter more than one degree, as applicable)
Country of the institution that
granted the degree (please do not use
Institution that granted the degree (please do not use acronyms)
acronyms)
When did the education program begin?
(required; please enter date in MM/YYYY format)
When did the educational program end or when is it
expected to end? (required;please enter date in MM/YYYY
format)
DOTH - OTHER DOCTORATE
UNITED STATES
A. I. DUPONT CHILDREN'S HOSPITAL
01/1996
12/1997
PHD - DOCTOR OF PHILOSOPHY
UNITED STATES
ABBVIE BIORESEARCH CENTER
04/1994
03/1999
Accomplishments: Career Highlights
Career Highlight / Leadership
Year Began (required; YYYY)
Please only enter accomplishments that can be attributed to T32-funded training.
Career Highlight /
Career Highlight/
Career Highlight / Leadership Narrative (required; Training Status When Accomplished
Leadership Year End
please provide a descriptive title/name for the leadership event)
(required)
Leadership Title (required)
(YYYY)
Accomplishments: Employment
Please only enter accomplishments that can be attributed to T32-funded training.
Training Status While Employed In Employment Year Employment Year
Job Title (required)
This Position (required; report your training Began (required;
End (YYYY)
status when you obtained employment)
YYYY)
Post-Training
Post-Training
2007
Unknown
Test
Country of
Employment
UNITED STATES
Name of Employer
ALLAN HANCOCK COLLEGE
Employment Sector
(required)
Other
Academia
Major Emphasis of this
Position (required)
Administration
Is this a Post-Doc
Position? (required; Yes,
No)
No
No
Tenure Status
(required)
Tenure track
Topic Area for Position
AIR QUALITY - INDOOR (COOKSTOVES)
Accomplishments: Fellowship
Please only enter accomplishments that can be attributed to T32-funded training.
Training Status When Fellowship
was Accomplished / Awarded
Fellowship Name
(required)
(required)
Post-Training
Test
Awarding Institution
or Agency (required)
Test
Year Received
Associated Research Sponsor
(required; YYYY)
1998
KLINGENSTEIN FUND
Associated Research
Sponsor - Other
Test
Accomplishments: Honors/Awards
Please only enter accomplishments that can be attributed to T32-funded training.
Training Status when you Received/Accomplished the
Honors/Awards (required)
In-Training
Name of Honor/Award/
Recognition (required)
Test
Awarding Entity (name of the
institution or agency that granted the honor
or award)
Test
Location of Awarding Entity
(please list country only)
UNITED STATES
Year Received or Initiated
(enter date as YYYY)
1996
Accomplishments: New Competitive Funding
New Competitive Funding is for funding obtained after training has been completed. To record support during the training period, please add a Research Sponsor on the In-Training Experience page on Tab 5.
Trainee’s Role on Post-Training
Funded Award
Collaborator
Start Date of Funded Award
Title of Award (required)
(required; MM/YYYY)
2008
Test
Award Number
Test
Name of Funding Organization (required)
AMERICAN FOUNDATION FOR AIDS RESEARCH (AMFAR)
Country Where Funding
Organization is Located
UNITED STATES
Accomplishments: Post-Training Education
Enter data about educational experiences obtained AFTER the trainee left the program. If the main degree program is captured in the In-Training
section, please do not repeat it here. This area is for additional educational experiences, POST-DOC, Certificate Program, etc.
Country of the Institution
Granting the Degree
(required)
UNITED STATES
Name of Institution Granting the Degree (required)
ALBANY COLLEGE PHARMACY
Educational Degree or Nature of Training
Program (required)
BOTH - OTHER BACCALAUREATE
Year the Degree
Earned (required; enter
date as YYYY)
1982
Accomplishments: Posters at Scientific Meetings
Please only enter accomplishments that can be attributed to T32-funded training.
Training Status When
Year Poster Presented
Number of Posters Presented at Scientific
(required;
YYYY)
Accomplished (required)
Conferences that Year (required)
In-Training
1996
23
Accomplishments: Product or Policy Development
Please only enter accomplishments that can be attributed to T32-funded training.
Training Status
When
Accomplished
Resulted in the Development URL or Citation for
or Implementation of
Product or Policy
Description of the Product or
Policy (required)
Significance of the Product
or Policy (required)
(required)
In-Training
New Degree Program
Test
Test
Test
Resulted in a
Demonstrable Effects on U.S.
Description of Significance of Effects on U.S.
Year of Product or
Patent Number
Country that Issued
Health Science and Public Health Health Science and Public Health Interventions
Policy Development Non-provisional (Answer if awarded a nonPatent
provisional patent)
(YYYY)
Patent (Yes, No)
Interventions (Yes, No)
1985
Yes
Test
UNITED STATES
Yes
Test
Accomplishments: Publications
There
are
3
tables
on
this
page.
Please
make
sure
you
scroll
all
the
way
down
and
review
all
3
tables.
Please
enter
publica;ons
that
can
be
a| File Type | application/pdf |
| File Title | TraineeProfile_BRADLEYAARON_08-21-2015 |
| File Modified | 2015-08-21 |
| File Created | 2015-08-21 |