Mentor Application

UW–Madison Biotechnology Training Program (BTP) Mentor Application Form

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

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List any other departments or graduate programs that you have an affiliate or joint faculty appointment.
As part of this application, please also include a copy of your NIH-style biosketch (using the new format; instructions, template and sample available at https://grants.nih.gov/grants/forms/biosketch.htm). Please provide a personal statement (Section A) that describes the appropriateness of your research background for the BTP training program, and your commitment to the following: • Training, mentoring, and promoting inclusive and supportive research environments; • Maintaining a record of, and training in rigorous and unbiased experimental design, methodology, analysis, interpretation and reporting of results; • Supporting trainees to transition into careers in the biomedical research workforce that are consistent with the trainees' skills, interests, and values; and • Fulfilling the need of the trainees to obtain their Ph.D. degrees in a timely fashion File must be less than 24MB. Allowed file types: pdf doc docx.
Accepted file types: pdf, doc, docx, Max. file size: 24 MB.
As part of this application, please provide a NIH-style Other Support document (instructions and sample available at https://grants.nih.gov/grants/forms/othersupport.htm) File must be less than 24MB. Allowed file types: pdf doc docx.
Accepted file types: pdf, doc, docx, Max. file size: 24 MB.
List of Non-Sponsored Funding
As part of this application, please include a list of all non-sponsored funding to include start-up, retention and foundation monies.
Funding Source (VCRGE, Dept., Foundation, etc.)
Type of funding (Professorship, Retention, Start-up, etc.)
Initial Award Amount
Dates for allowable spending
UW Project number (i.e. 135-ABC1234)
 
Briefly summarize the goals and focus of your research program. This information will be added to the BTP website.
Teaching Contributions
List all graduate-level (over 300) courses you teach. Please list the Course name, Department / Course Number, Dates of Course, Number of Lectures (i.e. MWF, once a week).
Course Name
Department / Course Number
Dates of Course
Number of Lectures (i.e. MWF, once a week)
 
Training Grant Participation
Please identify no more than three (3) T32 programs (including BTP) where you intend to participate as a faculty mentor.
Commitment to the BTP Program*
BTP mentors are required to participate in the Training Program. Please indicate which of the following activities you will participate in.
Consent*

If you have any questions, please contact Sarah Jacob at sjacob2@wisc.edu.