Welcome to the application for the Principles and Practice of Clinical Research 2018 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 coordinator@ppcr.org.
The application deadline is December 31, 2017.


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


Personal Information

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

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




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English Speaking Proficiency: (*)




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English Writing Proficiency: (*)




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English Listening Proficiency: (*)




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Professional and Academic Information

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

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




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




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




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The reasons I am applying for this course are (mark all that apply): (*)







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Learning Style
In order for us to learn more about your learning style, please complete the Barsch Inventory below:



Section I - Visual
I follow written directions better than oral directions. (*)



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I like to write things down or take notes for visual review. (*)



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I am skillful and enjoy developing and making graphs and charts. (*)



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I can understand and follow directions on maps. (*)



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I can better understand a news article by readings it rather than by listening to it on the radio. (*)



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I feel the best way to remember something is to picture it in your head. (*)



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I grip objects in my hands during learning periods. (*)



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I obtain information on an interesting subject by reading related materials. (*)



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Section II - Auditory

I can remember more about a subject through listening than through reading. (*)



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I require explanations of graphs, diagrams, or visual directions. (*)



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I can tell if sounds match when presented with pairs of sounds. (*)



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I do better at academic subjects by listening to tapes and lectures. (*)



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I learn to spell better by repeating the letters out loud than by writing the word on paper. (*)



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I would rather listen to a good lecture or speech rather than read about the same material in a book. (*)



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I prefer listening to the news on the radio than reading about it in the newspaper. (*)



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I follow oral directions better than written ones. (*)



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Section III - Kinesthetic

I bear down extremely hard when writing. (*)



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I enjoy working with tools or working on models. (*)



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I remember best by writing things down several times. (*)



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I play with coins or keys in pockets. (*)



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I chew gum, snacks, or smoke during studies. (*)



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I do a lot of gesturing and am well-coordinated. (*)



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I am good at working and solving jigsaw puzzles and mazes. (*)



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I feel very comfortable touching others, hugging, handshaking, etc. (*)



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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? (*)





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Do you put daily plans on paper? (*)





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Do you allow flexibility in your plans? (*)





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





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





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





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





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In which city will you be participating? (*)
































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

1.Curriculum Vitae (*)
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2.Letter of Intent (Why are you interested in this course? What are your goals? How will this further your career?) Maximum one page. (*)
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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). (*)
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4.Professional photo clearly showing your face – this will be used for the program website. You can always change it later on the website. (*)
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Click here for the Course Evaluation
Course student evaluation: (*)
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What component of this program are you applying for?







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