BTP Reporting Form

BTP Trainee Annual Reporting Form

Questions about this form? Contact Sarah Jacob at sjacob2@wisc.edu.

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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.

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."

Is any of your work part of a collaboration with a foreign contributor? (Yes/No)*

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)

Does this publication include foreign collaboration? (Y/N)

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)

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

Internship

Have you completed your required internship yet?*

Yes

Host Institution*

Internship Title*

Division/Department

Location (City, State)*

Start date–End date (mm/dd/yyyy–mm/dd/yyyy)*

Mentor/Contact Name*

Mentor/Contact Email*

Internship Type*

Education

Not-for-profit

Governmental Research

Research Institute

Biotech

Agriculture

Chemical

Healthcare

Pharma

To be Completed

Notes regarding success/value of internship toward graduate progress or career goals*

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).

Individual Development Plan

List the dates of IDP discussion with your mentor.

Click the + button on the right to add another date.

Date (mm/dd/yyyy)

Are there any interesting or noteworthy happenings related to your current work and/or lab?*

Please share any interesting stories, findings, or news. Examples may include criteria such as: Did something unexpected, surprising, or unusual happen? Did the work lead to a meaningful discovery, change, or insight? Does it demonstrate progress that would not be obvious from simply looking at the project description? Is there a human story behind it—persistence, problem-solving, collaboration, or an unexpected challenge?

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).

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