2019 Application


Welcome to the application for the Principles and Practice of Clinical Research 2019 program. Only submit this form if you want to apply for the program. If you would like more information before applying or have questions about this application, please contact us at 2019coordinator@ppcr.org. Application due date is December 31, 2018, please make sure you submit your application as soon as possible in order to guarantee your place.


*Please complete all fields using standard format of capital letters at the beginning of words and lower case for remaining


Personal Information

First Name (*)
Invalid Input
Middle Name (*)
Invalid Input
Last Name (*)
Invalid Input
Full name as it appears on your passport (*)
Invalid Input
Preferred First Name (*)
Invalid Input
Country of Citizenship (*)
Invalid Input
Country of second citizenship (if applicable) (*)
Invalid Input
Street Address (max. 60 characters) (*)
Invalid Input
City (*)
Invalid Input
Country (*)
Invalid Input
State (*)
Invalid Input
Zip Code
Invalid Input
Phone Number (Numbers only, no symbols please) (*)
Invalid Input
Email Address (*)
Invalid Input
Re-enter your email address (*)
Invalid Input
Alternative Email Adress (*)
Invalid Input


Language Proficiency

What is your Native Language? (*)
Invalid Input
Mark below your proficiency in English (if you are a Native English Speaker, mark N/A for the questions below):
English Reading Proficiency: (*)




Invalid Input
English Speaking Proficiency: (*)




Invalid Input
English Writing Proficiency: (*)




Invalid Input
English Listening Proficiency: (*)




Invalid Input

Professional and Academic Information

Highest Degree (*)
Invalid Input
University of Highest Degree (*)
Invalid Input
Year of Graduation (*)
Invalid Input
Current Position (*)
Invalid Input
Current Institution (*)
Invalid Input
Specialty (*)
Invalid Input
Number of Peer-reviewed National Publications (if you have not published before, then type 0) (*)
Invalid Input
Number of Peer-reviewed International Publications (if you have not published before, then type 0) (*)
Invalid Input
Number of Grants You Have Received as the Principal Investigator (If you have not received any grants, then type 0) (*)
Invalid Input
Have you done a peer review for a journal? (*)
Invalid Input
Have you had previous formal training in clinical research (please cite the training programs and approximate total hours of training)? (*)
Invalid Input
Have you run clinical trials as a Principal Investigator? (*)
Invalid Input
Please identify which level of statistics best describes you: (*)

How did you hear about this course? Please be specific. (*)
Invalid Input


Computer Skills and Expertise

Please rate your level of computer expertise (i.e., an expert would be someone who uses a computer frequently for his/her work and is comfortable learning new applications and software; no experience indicates someone who rarely uses a computer [even for emails or accessing the web] and has difficulties learning new applications). (*)




Invalid Input
How many distance-learning courses have you taken? (*)




Invalid Input



In order for us to understand if you are familiar and would adapt well to a distance-learning program and also your group work skills, please respond to the statements below (your responses will not influence your acceptance into the program):

I am self-disciplined, work well independently and usually complete assignments on schedule. (*)
Invalid Input
I can devote 3-5 hours per week to the course, in addition to the 3-hour lecture. (*)
Invalid Input
I have strong written communication skills. (*)
Invalid Input
I use email, phone and text messages frequently in my work. (*)
Invalid Input
I can download software from the web and install applications with no need for assistance. (*)
Invalid Input
I have access to (mark all that apply): (*)




Invalid Input


Time Management Skills

In order for us to learn about your time management skills, as this is critical for successful completion of the course, please answer the questions below (from Dartmouth University – Academic skills center - http://www.dartmouth.edu/~acskills/success/time.html).

How often do you plan in an effort to keep life from running out of control? (*)





Invalid Input
Do you put daily plans on paper? (*)





Invalid Input
Do you allow flexibility in your plans? (*)





Invalid Input
How often do you accomplish all of your plans for a given day? (*)





Invalid Input
How often do you plan time for what matters most to you? (*)





Invalid Input
How often is your daily plan destroyed by urgent interruptions? (*)





Invalid Input
Why did you choose this program? Mark all that apply: (*)










Invalid Input
What are your goals for taking this educational program? Mark all that apply (*)





Invalid Input
Do you agree with this sentence below: “Learning is a long process, only attending to a lecture has a minimal impact; most of the learning happens actively when the student is engaged reflecting about the subject” (*)



Invalid Input
One of the editors of BMJ has said “99% of research is flawed”. What do you think of this statement? (*)



Invalid Input
Have you taken clinical research methodology courses before (including statistics and epidemiology)? (*)




Invalid Input
If you did take a clinical research course before, why do you want to take PPCR? (*)



Invalid Input
Do you think you can learn from a student taking PPCR with you? (*)



Invalid Input
You're born with a certain amount of intelligence and it isn't something that can be changed. (*)



Invalid Input
Your intelligence can increase or decrease depending on whether or not you keep focused time reflecting, studying and learning. (*)



Invalid Input
Talent is not something you can develop. We are born with specific talent that cannot be modified. (*)



Invalid Input
If you are committed to practice something you can indeed develop a talent for it. (*)



Invalid Input
I agree to the following statements - it is necessary to agree with all items: (*)





Invalid Input
In which city will you be participating? (*)














































Invalid Input



Please upload the following documents as PDF files. (All documents must be submitted in English):

1.Curriculum Vitae (*)
Invalid Input
2.Letter of Intent (Why are you interested in this course? What are your goals? How will this further your career?) Maximum one page. (*)
Invalid Input
3.Recommendation Letter (please upload one recommendation letter from someone who can provide an academic or professional reference about you. For instance, previous or current instructors, preceptors, or employers). (*)
Invalid Input
4.Professional photo clearly showing your face – this will be used for the program website. You can always change it later on the website. (*)
Invalid Input
Click here for the Course Evaluation
Course student evaluation: (*)
Invalid Input
What component of this program are you applying for?







Invalid Input

Contact Us