The application for PSTP program is closed.

Application Form

All fields must be completed for application submission.

 
  Demographic Information:
  AMCAS ID: *8 digits with no dashes, spaces, etc.
  Prefix:
  First Name:
  Middle Name:
  Last Name:
  Email:
  Preferred Phone:
  Preferred Address:
  Preferred City:
  Preferred State:
  Preferred Zip:
  International Student applying to the PSTP?
  If Yes, Citizenship?
  Undergraduate School:
  Undergraduate Degree:
  Undergraduate Degree Date: /
 
 
 
 

Curriculum Vitae Information

 
EMPLOYMENT HISTORY: (List in chronological order with most recent first; include position dates & details)
 
 
EDUCATION: (Include dates, majors, and details of degrees, training and certification--undergraduate, graduate, post-doctoral training)
 
 
AWARDS/HONORS: (Type, date/year)
 
 
ORAL/POSTER PRESENTATIONS (specify if oral or poster): (Date, location, event, authors)
 
 
JOURNAL PUBLICATIONS: (Authors, title, journal, date)
 
 
ABSTRACTS: (Date, location, event/journal, authors)
 
 
OTHER EXTRACURRICULAR ACTIVITIES OR PROFESSIONAL CERTIFICATIONS OR SKILLS:
 
 
 
DESCRIBE YOUR EXPOSURE TO CLINICAL MEDICINE (SHADOWING OR OTHER EXPERIENCE)? (<500 words)
 
 
 
WHY ARE YOU INTERESTED IN ACADEMIC MEDICINE? (<500 words)
 
 
PLEASE DESCRIBE KEY FEATURES, HYPOTHESES, & SIGNIFICANCE OF RESEARCH EXPERIENCES AND WHAT YOUR ROLE WAS (<1000 words)
 
 
 
 
PLEASE LIST 1 INDIVIDUAL YOU WOULD LIKE TO WORK WITH AT THE UNIVERSITY OF PITTSBURGH.
FACULTY NAME:
RESEARCH AREA INTEREST:
SECONDARY AREA:
 
WHY WOULD YOU LIKE TO WORK WITH THIS INDIVIDUAL? (<500 words)
 
LIST 3 OTHER FACULTY IN YOUR FIELD OF RESEARCH INTEREST AT THE UNIVERSITY OF PITTSBURGH (that you would like to meet and/or are interested in learning more about) (see preapproved faculty list on website for ideas)
1.
2.
3.
 
 
 
 
IF YOU ARE A CURRENT MS-2 PITT MEDICAL STUDENT, PLEASE COMPLETE THE FOLLOWING 2 QUESTIONS:

IN ADDITION, PLEASE CONTACT THE REGISTRARS OFFICE (412-648-9040) AND MAKE ARRANGEMENTS TO HAVE A COPY OF YOUR PITT MEDICAL SCHOOL TRANSCRIPT DELIVERED TO THE PSTP OFFICE (529B SCAIFE HALL).
 
  Research Advisor Name:
  Research Advisor Department/Division:

  Lab Administrator Name:
  Lab Admin Phone:
  Lab Admin Fax:
  Lab Admin Email:
  Lab Address:

TITLE OF PROPOSED RESEARCH:
HAS PROPOSED RESEARCH RECEIVED FUNDING?
IF YES, GRANT APPLIED & DATE:

  Training Plan (Previous, proposed and future research training) (<500 words)
 
 
  Research Plan (Background, Specific Aims and Hypothesis, Experimental Plan) (< 2000 words)
 
 
 
 
ALL APPLICANTS MUST COMPLETE INFORMATION BELOW
 
  Recommendations: 
  • When you submit your application, your recommenders will receive an automatically generated email with instructions, a login id, & password to access the PSTP required recommendation form located at the PSTP web site.
  • Your application will NOT be complete until your references have completed the recommendation form.
  • You may ask the same recommenders as on your AMCAS application but they are still required to complete the PSTP recommendation form.
 
  Reference 1  
  Name:
  Email:
  Prefix:
  Title:
  Institution:
  Department/Division:
  Address:
  City:
  State:
  Zip:
  Phone:
 
  Reference 2  
  Name:
  Email:
  Prefix:
  Title:
  Institution:
  Department/Division:
  Address:
  City:
  State:
  Zip:
  Phone:
 
 
 
This application is closed.