PREPARE Applicants

Fill out this form if you are a Department of Medicine Faculty member and would like to request a review of a concept sheet or full proposal.

First name*

Last name*

Email address*

EID*

Enter you UCSF employee ID here

Division*

Select

Primary location*

At which campus do you primarily conduct your research?

Select

Faculty rank*

Select

Does your racial or ethnic make-up qualify you as an underrepresented minority (URM)?*

See https://diversity.ucsf.edu/URM-definition for a working definition

Select or enter value

Gender*

Select or enter value

Terminal degree (no punctuation)*

Are you a lab scientist or clinical scientist?*

Select or enter value

Are you a biostatistician (Y/N)?

(Check box if yes)

Award type applying for*

If other, please type in entry

Select or enter value

Submission type

Select

Anticipated date of submission*

Preferred review month

Choose the month you'd prefer your review to take place in if your submission deadline is more than two months away

Select

Review type requested*

Select

Proposal title*

Brief description of proposal*

Keywords (separated by commas)*

Who are your UCSF Co-Is?

Requested reviewer(s) (separated by commas)

Reviewer(s) to exclude (CONFIDENTIAL)

Use this field if there are relationships that pose a conflict of interest

Additional comments

Please add any other comments that will assist us with your submission. If this is a resubmission, please indicate the original title or application number (if you have it).

Send me a copy of my responses

Privacy Notice|Report Abuse