Clinical Research Enhancement through Supplemental Training (CREST)
Scholar Application   

    Today's Date                    

    Scholar Name                 

    Telephone Number(s)  

    E-Mail Address               

    Mailing Address                City   State, Zip

   Doctoral Candidate           Fellow           Faculty   Other:

    If doctoral candidate or fellow, anticipated date of completion of fellowship/doctoral degree:
   Do you have a K-23/K-08 grant?       Yes          No
                                                           Potential grant funding date:

    Which CREST Track are you applying for?
     Track I (individual course(s)            Track II (full 2-year program)

    If Track I, which course(s) are you interested in taking?
    (Course descriptions and schedules are available on the web at http://crest.ucsd.edu)
Epidemiology I Biostatistics I
Epidemiology II Biostatistics II
Patient-Oriented Research I Health Services Research
Patient-Oriented Research II Data Mgmt & Bioinformatics
Scientific Communication Skills Personal Development Skills/
  Research Budgeting and project management
   
   Do you have a current research project?    Yes   No  

   If yes:

    Name of Mentor/Supervisor
    Title of Principal Research Project
    Brief Description of Principal Research Project 
 
    Briefly, what are your career goals?
 
   What do you hope to gain from participating in the CREST program? 
  
    How did you hear about the CREST program? 
 
    Please attach your CV

    Agreement of primary supervisor (e.g. Program Director, Research Advisor, Division Chief, Clinical Supervisor)

I support the applicant's participation in the CREST program. The CREST course is offered from 4-6 PM on
Wednesday at Hillcrest (UC Medical Center) and Thursday at La Jolla (UC Extension) with identical classes
by the same instructor at each site. I certify that participation in the CREST program on Wednesdays/Thursdays
will not conflict with her/his research, clinical or other duties. I will provide protected time for her/him to participate
in CREST activities on Tuesday ----Wednesday ------; Thursday------. I understand that there is a fee associated with the
program that will be paid by the scholar---- / department----.


             


Supervisor Signature

Name (printed)

Please return completed application by mail or fax to:

CREST Office

UCSD Medical Center

200 W. Arbor Dr., #8342

San Diego, CA 92103

E-mail: schernet@ucsd.edu

Fax: (619)543-7769

 

Application Deadlines: For Track II students, the deadlines are November 15 for the January session and
May 15 for the June session. Track I students can apply at any time since enrollment is on a space available basis.

After your application has been reviewed a member of the CREST faculty will contact you. If you have any
questions before then, please contact CREST office at 619-543-7298, by e-mail schernet@ucsd.edu

Scholar application and payment instruction can be found at the CREST Website: http://crest.ucsd.edu

For those who are interested in the Master of Advanced Studies in Clinical Research degree, there will be additional university fees for each quarter of enrollment. Details of the Masters Degree program and fees can be found at the web site http://clre.ucsd.edu / (contact Maureen Eijsermans at unexhealthcare@ucsd.edu)

CREST Website: http://crest.ucsd.edu
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