Urology Unbound P.I. Volunteer Form Question Title * 1. Name Question Title * 2. What is your email? Question Title * 3. Institution Question Title * 4. Which level learner do you want to work with Undergraduate student Post-bacc/Graduate student Medical Student USMDs/IMGs Urology Resident Question Title * 5. Trainee must be local? Yes No Question Title * 6. If yes, which City & State? Question Title * 7. Name of the Project/Project Idea: Question Title * 8. Description of the project (limit to 4-6 sentences): Question Title * 9. Is there a stipend available for trainee? Yes No Question Title * 10. Will you provide funding for trainee travel/meeting costs? Yes No Maybe Question Title * 11. Type of Projects Literature Review Case Report Video Abstract Meta-analysis Retrospective Study Prospective Study Question Title * 12. Subject (if applicable) General Urology Basic science/bench research Oncology Pediatrics Transplant Endourology Sexual Med/Prosthesis FPMRS Genitourinary reconstructive surgery Infertility Medical Education Health Inequities/disparities Other (please specify) Question Title * 13. Expected productivity within next 12 months Abstract authorship Abstract presentation at meeting Manuscript authorship Authorship on manuscripts, abstracts, etc greater than 12 months Question Title * 14. Expected Time commitment 5 hrs/wk 10hrs/wk 15hrs/wk 20hrs/wk >20hrs/wk (full time) Question Title * 15. Expected time to project completion 3 months 6 months 9 months 12 months >12 months Question Title * 16. Trainee responsibilities Literature search Manuscript writing Database development/data entry Data analysis/data interpretation Questionnaire development Attend weekly lab meetings Patient interview Study subject recruitment/management Clinical work Statistical analysis Other (please specify) Question Title * 17. How many trainees have worked with you in the last 12 months? 1 2 3 4 5 or more Question Title * 18. How many trainees are you willing to accept in this project/program? 1 2 3 4 Other (please specify) Question Title * 19. Can you mention any recent publications/projects/presentations completed by trainees that previously worked with you? if not, please type NA Question Title * 20. Please name any other research opportunity you are aware of Done
