BTP Reporting Form BTP Trainee Annual Reporting Form Questions about this form? Contact Cheri Stephens at cheri.stephens@wisc.edu. Step 1 of 8 12% Basic InformationTrainee 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 PresentationsShort 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 TitleLocationDate(s) (mm/dd/yyyy–mm/dd/yyyy)Title of PresentationPoster 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)YearTitleJournalVolume(Issue): Inclusive pagesPMCID (required for pubs in print)Role (examples below question) Career DevelopmentFellowships 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 TitleGranting AgencyDates (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 TitleGranting AgencyDate(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 TitleDate(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.EventRoleDate(s) (mm/dd/yyyy) CourseworkFoundations of Biotechnology Class (semester taken or planned)*SemesterYearBTP Seminar*Click the + button on the right to add another semester.SemesterYearTitle/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. DepartmentCourse NumberCourse Title Responsible Conduct in Research (aka Ethics) Course (Original, 1st year)*DepartmentCourse NumberCourse TitleSemesterYearResponsible Conduct in Research (aka Ethics) Course (Refresher, 4th year)RCR is required every four years, no matter your current funding source. DepartmentCourse NumberCourse TitleSemesterYearRigorous and Reproducible Research courseTrainees 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.DepartmentCourse NumberCourse TitleSemesterYearMinor* Biological Physical Courses Taken Toward BTP Minor (other than RCR, BTP seminar, and Foundations)Click the + button on the right to add another course.DepartmentCourse NumberCourse TitleSemester InternshipHave you completed your required internship yet?* Yes No 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 ExperiencePrior 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 PlanList 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) Research Protocols Covering your Graduate WorkBiosafetyProtocol NumberExpiration Date IACUC (Animal Use)Protocol NumberExpiration Date IRB (Human Subjects)Protocol NumberExpiration Date Stem CellsProtocol NumberExpiration DateNIH 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.