Skip to content
TRAIN Pharmacy Grant Thrombosis/Hemostasis Residency Award and Innovation Network Spring 2025 Application Cycle
1.
Applicant Information:
Organization Name
Department
First Name
Last Name
Degree
Title
Email
Phone Number
2.
How many total PGY2 pharmacy resident and fellowship positions does your health system currently have?
3.
Which of the following PGY2 pharmacy residency programs are currently available at your health system (check all that apply)?
Ambulatory Care
Cardiology
Critical Care
Emergency Medicine
Geriatrics
Infectious Disease
Informatics
Internal Medicine
Investigational Drugs and Research
Medication Use Safety and Policy
Neurology
Oncology
Pediatrics
Pharmacotherapy
Other (please describe)
4.
If your organization currently offers a Pharmacist Fellowship program, please describe it here:
5.
Please describe your candidate recruitment plan (including do you offer early commitment)- word limit 1,000 characters:
6.
Please describe baseline requirements you seek in residents:
7.
Is your institution an Anticoagulation Forum Center of Excellence (this is not a requirement)?
8.
Program Description:
Please upload a description of your potential residency program, including:
1. Brief curriculum outline and learning experiences you intend to offer. Distinguish between required and elective experiences, and indicate whether each is a formal block or longitudinal.
2. The institution’s current service(s) in thrombosis and hemostasis management
3. The pharmacy department’s involvement in managing thrombosis and hemostasis
4. Description of any current or planned thrombosis and hemostasis stewardship activities
5. Potential preceptors to be involved in residency training (include a short bio of each primary preceptor and the related rotation). Please also identify a proposed residency program director.
6. Research opportunities for the resident
File size limit is 16MB
Choose File
No file chosen
9.
Budget:
Note: The grant award is $120,000 paid over 2 years and is meant to provide budget support towards 1 resident in each of the 2 academic years. Additional institutional support will be needed to augment the TRAIN grant funding.
Salary:
Preceptor Support:
Institutional Overhead (maximum 10% of grant award):
Conference Support, including registration and travel:
Other: (if none enter N/A)
If you entered an amount in Other, please describe, otherwise enter N/A:
Total Budget (Maximum $120,000):
Please upload 2 letters in support of this training program:
10.
Director of Pharmacy
File size limit is 16MB
Choose File
No file chosen
11.
Physician champion with practice focus in thrombosis and hemostasis
File size limit is 16MB
Choose File
No file chosen
12.
Please provide any additional information that you would like to share with the Anticoagulation Forum selection committee:
Send me a copy of my responses via email
