AAS/AASF Trainee Research Award Application "*" indicates required fields Step 1 of 4 25% Please select the grant you are applying for*Select one AAS/AASF Basic Science/ Translational Research Trainee Fellowship Award AAS/AASF Clinical Outcomes/Health Services Research Trainee Fellowship Award AAS/AASF Education Research Trainee Fellowship Award AAS/AASF Global Surgery Research Trainee Fellowship Award Name* First Last Email* Gender* Female Male Transgender Female Transgender Male Gender Variant/Non-conforming Prefer not to answer Other Race/Ethnicity* American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White or Caucasian AAS Membership Status*Note: You must be a member to submit an application. Membership will be verified. If your membership application is currently under review, you are still eligible to apply. I am a Candidate Member I am an Active Member My application is under review Surgical Status* Medical Student Resident Fellow Current PGY Level PGY-1 PGY-2 PGY-3 PGY-4 PGY-5 Are you an active member of the military?* Yes No Institution* Department* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*In the case we need to reach you regarding your submissionAre you doing your research year at another (secondary) institution?* Yes No Institution* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Research Interests* Basic Science Translational Clinical Outcomes/Health Services Education Global Health Surgical Discipline(s)* Acute Care Surgery Bariatric Cardiothoracic Colorectal Critical Care Endocrine General Surgery GI/HPB Minimally Invasive Pediatric Surgery Plastics Surgical Oncology Transplant Trauma Vascular Other Proposal Title* Mentor Name*Your mentor must be an AAS member. Membership will be verified. First Last Has this proposal been or will be submitted to other extramural funding sources?* No/None NIH-NRSA ACS SUS SIS Other Supporting DocumentsALL DOCUMENTS MUST BE UPLOADED AS ONE FILE IN PDF FORMAT (REQUIRED). Grants which are incomplete or do not follow the page limits or formatting guidelines will not be reviewed. Uploaded supporting documents will NOT BE SAVED if you select Save & Continue. Documents will only be saved upon submission of your application. - Cover Letter (Limit: 1 page) - Should outline your academic development plan for the one-year research period, short and long-term career goals, and any other relevant information that you wish the committee to consider. - Curriculum Vitae or NIH-style Biosketch (Limit: 5 pages) - Lay Summary of Project (Limit: 200-300 words) - Comprehensive Research Plan (Limit: 5 pages) single-spaced, Arial 11pt, 1" margin, excluding references. Must include: 1. abstract for research proposal 2. significance of research 3. background information 4. preliminary observations 5. experimental plan (methods, materials, potential limitations and pitfalls) - Budget (Limit: 1 page) - Brief budget justification. Must include 10% use for travel. - Letter from Sponsoring Research Mentor (Limit: 2 pages) - Must outline the mentoring plan, and describe their past mentoring experience and track record. The letter should also confirm the research plan, as well as the availability of resources to complete the proposed research. - Letter of Support from the Chair of your Department (Limit: 2 pages) - The letter must guarantee that the applicant will spend the entire funding period in the research fellowship and that the department is committed to providing the additional support necessary to ensure completion of the project. - Research Mentor’s NIH-style Biosketch (Limit: 5 pages) Applications which exceed the page limitations WILL NOT BE REVIEWED.Upload*Due to the large file size, submission make take 3-5 minutes. Do not re-submit or leave the application page once you have clicked submit. You will be directed to a confirmation page once your application has been successfully completed. NOTE: YOUR UPLOAD WILL NOT SAVE IF YOU SELECT 'SAVE AND CONTINUE'Accepted file types: pdf, Max. file size: 512 MB.CommentsThis field is for validation purposes and should be left unchanged. 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