BTP Reporting Form

Basic Information
Trainee Name*
Graduate Program*
Major Professor*
First years who haven't joined a group, please state "not yet determined."
Minor Professor*
First years who haven't chosen yet, please state "not yet determined."
Degree Pursuing*
- Ph.D.
- M.D./Ph.D.
LinkedIn Profile Page URL*
Required because of NIH's 15 year tracking requirements.
Personal (non-UW) email address (e.g. gmail)*
Required because of NIH's 15 year tracking requirements.

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Research Progress and Presentations
Short Research Title*
First years without set research path yet, please state "not yet determined."
Research Description and Progress (one paragraph)*
Will appear on BTP website trainee profile and hence be publicly viewable. First years without set research path yet, please state "not yet determined."
Conference Presentations (During Entire Graduate Career at UW–Madison)
Click the + button on the right to add another conference.
Conference Title Location Date(s) (mm/dd/yyyy–mm/dd/yyyy) Title of Presentation Poster or Oral? BTP Funds used to attend? (Y/N)
Planned or Published Papers and Role (During Graduate Career at UW–Madison)
(Role examples: designed or conducted experiment, analyzed data, drafted paper, etc.) Click the + button on the right to add another paper.
Authors (ex: Doe JD, Smith TJ) Year Title Journal Volume(Issue): Inclusive pages PMCID (required for pubs in print) Role (examples below question)

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Career Development
Fellowships or Other Support (Received During Graduate Career)
(e.g. AOF, NSF Graduate Research Fellowship, NIH F31, etc.) Click the + button on the right to add another row.
Fellowship Title Granting Agency Dates (mm/dd/yyyy–mm/dd/yyyy)
Awards/Honors (During Last 12 Months)
(e.g. departmental awards, best poster, etc.) Click the + button on the right to add another award.
Award Title Granting Agency Date(s) (mm/dd/yyyy–mm/dd/yyyy)
Workshops or Career Development Activities Attended (During Last 12 Months)*
(e.g. Life Science Career Day, departmental career development sessions, etc. NOTE: BTP requires that you attend at least one career development activity per year. Click the + button on the right to add another activity.
Workshop/Activity Title Date(s) (mm/dd/yyyy)
Outreach Activities (During last 12 Months)
(e.g. Wisconsin Science Festival, ChOPS/BOPS/Engineering Ops host, etc.) Click the + button on the right to add another activity.
Event Role Date(s) (mm/dd/yyyy)

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Coursework
Foundations of Biotechnology Class (semester taken or planned)*
Semester Year
BTP Seminar*
Click the + button on the right to add another semester.
Semester Year Title/Topic of your Seminar Presentation, if given that semester
Courses Taken toward Major (other than 990 research credit)*
Click the + button on the right to add another course.
Department Course Number Course Title
Responsible Conduct in Research (aka Ethics) Course (Original, 1st year)*
Department Course Number Course Title Semester Year
Responsible Conduct in Research (aka Ethics) Course (Refresher, 4th year)
RCR is required every four years, no matter your current funding source.
Department Course Number Course Title Semester Year
Rigorous and Reproducible Research course
Trainees are required to take a course on ways to carry out rigorous and reproducible research for the BTP minor. This course may overlap with a course that counts toward the BTP minor.
Department Course Number Course Title Semester Year
Minor*
- Biological
- Physical
Courses Taken Toward BTP Minor (other than RCR, BTP seminar, and Foundations)
Click the + button on the right to add another course.
Department Course Number Course Title Semester

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Previous Research Experience
Prior to beginning graduate school, approximate months of full‐time research experience*
Calculation Instructions: For many individuals, this value will reflect months of summer research experience or full‐time research experience following college. For those with part‐ time, academic‐year research experience for academic credit, convert the part‐time experience to full‐time for reporting here (e.g., 15 hours/week for 8 months=3 months). Do not include labs associated with a course (e.g. organic chemistry course with lab).

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Individual Development Plan
List the dates of IDP discussion with your mentor.
Click the + button on the right to add another date. Be sure each discussion was entered into the IDP tracking tool at http://my.gradsch.wisc.edu/idp/myUWIDP.pl and marked as “Confirmed” by your mentor.
Date (mm/dd/yyyy)

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Research Protocols Covering your Graduate Work
Biosafety
Protocol Number Expiration Date
IACUC (Animal Use)
Protocol Number Expiration Date
IRB (Human Subjects)
Protocol Number Expiration Date
Stem Cells
Protocol Number Expiration Date NIH hESC Registration Numbers (for Stem Cell Protocols)
Consent*
I understand my information is being used for campus and NIH reporting purpose(s).
No further edits can be made after clicking submit.
Name
This field is for validation purposes and should be left unchanged.

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Basic Information

Conference Title	Location	Date(s) (mm/dd/yyyy–mm/dd/yyyy)	Title of Presentation	Poster or Oral?	BTP Funds used to attend? (Y/N)

Authors (ex: Doe JD, Smith TJ)	Year	Title	Journal	Volume(Issue): Inclusive pages	PMCID (required for pubs in print)	Role (examples below question)

Fellowship Title	Granting Agency	Dates (mm/dd/yyyy–mm/dd/yyyy)

Semester	Year	Title/Topic of your Seminar Presentation, if given that semester

Protocol Number	Expiration Date	NIH hESC Registration Numbers (for Stem Cell Protocols)

Workshop/Activity Title	Date(s) (mm/dd/yyyy)

Event	Role	Date(s) (mm/dd/yyyy)

Department	Course Number	Course Title

Department	Course Number	Course Title	Semester