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Physician-Scientist Experience Application

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OHSU medical students in good academic standing are eligible to apply. Applicants are selected based on demonstrated interest in an in-depth research experience and are notified of acceptance to program by mid-January.

This survey tool is set up to collect some demographic and application information. Please follow instructions given in the request for application for content and format.

This online form allows applicants to save and return where left off to complete the form any time in the future. You will be given a validation code, which is required to enter in order to continue the survey.

If you have any questions, please feel free to call us (503)-494-3095 or email Karen McCracken (mccracke@ohsu.edu).

Thank you!

Select option for which you are applying:
This is not a final commitment to this track. Once accepted, you can change with permission.

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Five-month option

One-year option

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First Name:

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MIddle Name or Initial:

Last Name:

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OHSU Student ID:

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Year matriculated to MD program:

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Provide a brief summary of any previous research experience.

Limit to less than 250 words.

* must provide value

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Please describe how training in the Physician-Scientist Experience will contribute to your future career. Include any skills or competencies that you most want to learn or experience while in this program.

Limit to less than 250 words.

* must provide value

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Describe how you see research as part of your career as a physician.

Limit to less than 250 words.

* must provide value

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Do you have a specific mentor or research area in mind?

Please note that it is acceptable to not know at this time. You will have time to explore feasible research projects and appropriate mentors with assistance of the program. Any research project or mentor selection will need final approval from the program per specific guidelines prior to the start of your research rotation or year-out.

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Upload a curriculum vitae. Submit as a single PDF or Word document with the label Lastname_CV.docx (or .pdf)

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Upload file

Gender:

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Female

Male

Prefer not to state

Not listed above (please specify)

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What is your gender identity if not listed above?

Ethnicity:

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Hispanic/Latino

Not Hispanic

Prefer not to state

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Racial background:
(mark one or more)

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American Indian or Alaskan Native

Asian

Black or African American

White

Native Hawaiian or Pacific Islander

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Do you have a disability?

None

Hearing

Mobility/Orthopedic Impairment

Visual

Other

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NIH has recently revised the criteria for determining if someone is from a disadvantaged background. This is really important to NIH and we would appreciate it if you would read this and consider the following before answering the next question.

An individual is considered to be from a disadvantaged background if the answer is yes to two or more questions below (1-7).
1. Were or currently are homeless.
2. Were or currently in the foster care system for any period of time
3. Were eligible for the Federal Free and Reduced Lunch Program for two or more years
4. Have/had no parent or legal guardian completed a bachelor's degree
5. Were or currently are eligible for Federal Pell grants
6. Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child
7. Grew up in one of the following areas: a) a U.S. rural area, as designated by the Health Resources and Services Administration (HRSA) Rural Health Grants Eligibility Analyzer (https://data.hrsa.gov/tools/rural-health), or b) a Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas (qualifying zipcodes are included in the file). Only one of the two possibilities in #7 can be used as a criterion for the disadvantaged background definition.

From: https://era.nih.gov/commons/disadvantaged_def.htm

Are you from a disadvantaged background?

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Yes

Prefer not to state

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Citizenship:

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U.S. Citizen or U.S. Noncitizen National

Permanent Resident

Non-resident

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Application Decision

Application Year

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.