Sample Format Table 5 for Non-Competing (Type 5) IMSD Grant Applications

Table 5 – Information of Former IMSD Program Participants

Grant Number: __________________________________

Reporting Period: __________________________________

Institution: __________________________________

Program Director: __________________________________

Program Participants Information

Student Name*                                        (Last name, First name) Phone Email UR*  Group UR1  Group Gender Degree Pursued Institution Current Status
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 

* NOTE: Per program announcement: U.S. citizens or non-citizen nationals or permanent residents and must be matriculated full-time at the applicant institution

Instructions:

  1. For each student, provide the text for the (name, phone, email, degree pursued and institution) and click on each cell to select from the drop down list the appropriate answer for the other criteria.
  2. If you need to add rows, copy any row within the table and paste it at the end of the table.

Coding:
1. UR* Group:
AA - African American
H - Hispanic 
NA - Native Americans (including Alaska Natives)
NP - Natives of the U. S. Pacific Islands

2. UR1 Group:
P - individuals from other underrepresented groups that the grantee institution's established written policies can convincingly demonstrate to be underrepresented in biomedical/behavioral sciences
D - individuals with dissabilities
DB - individuals from disadvantage backgrounds

3. Gender:
F - Female
M - Male

4. Current Status
PhD (MD/PhD)
Post Doctorate
MD
Other Professional Degree
Faculty Position
Other Research Non-Academic Career