This form defines the Scholarly and Research Project as per the PGE Policy. It should be jointly completed by the resident and supervisor. Please see the PGE Policy and Resident Checklist for roles, responsibilities, timelines and deliverables.

Please send an email to Dr. Elton Ngan (elton.ngan@ubc.ca), Director of Scholarly Activity, to let him know that you've completed this.

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* 1. Name - Resident's last name

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* 2. Name - Resident's first name

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* 3. PGY Year

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* 4. Type of Project

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* 5. Project Supervisor's Name

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* 6. Supervisor's email address

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* 7. Co-supervisor (if applicable)

Note: Project supervisors are expected to be faculty members. If not, please discuss with Director of Scholarly Activity before proceeding. For any projects conducted in human or animal subjects (including many chart reviews), ethics approval will likely be required, so supervisors will need to be registered with the UBC Research Information System (RISe, www.rise.ubc.ca). Please note that ethics approval for a new project may take up to 3-6 months to complete.

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* 8. Is ethics approval required for your project?

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* 9. If YES, give date of ethics certificate obtained, or date that you expect to submit an ethics application.

Date

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* 10. Title of Project

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* 11. Primary question or hypothesis (one line)

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* 12. Description of Project (briefly describe the objectives and methods, 300-500 words) - note, each text box holds approx 250 words.

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* 13. Description of Project (Continued...)

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* 14. Other information or comments:

Thanks for completing the form! Please send an email to Dr. Elton Ngan (elton.ngan@ubc.ca), Director of Scholarly Activity, to let him know that you've completed this.
FOR ADMINISTRATIVE USE ONLY:

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* 15. Project approved

Date

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* 16. Project presented

Date

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* 17. Where presented?

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* 18. Project report completed

Date
Date

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* 19. Type of report

T