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African Cancer Stars
Strategic Training Achievements for Research Success
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Key Dates
Contact Information
First Name
Middle Name
Surname
Title
Position
Institution, Department
Address
City, Postcode, Country
Contact phone
Email
Training Track
- Select -
Principal Investigator Track (PI- STARS)
Project Manager Track (PM- STARS)
Training Track
English Language Proficiency
- Select -
Poor
Average
Good
Fluent
English Proficiency
Training Certifications
Human Subjects Research
Good Clinical Practice
Responsible Conduct of Research
Conflicts of Interest
Bioethics
Conflict Management
Project Management Professional
Certified Associate in Project Management
STARS Training Institution
Are you Affiliated with a Partner Organization? (Y/N) (See list; https://www.africancancerstars.org/partners)
- Select -
Yes
No
Name of Partner Organization
Organization Contact Name
Contact Email address
Is your institution included on the pre-approved training institutions list? (See list; https://www.africancancerstars.org/approved-institutions)
- Select -
Yes
No
Sponsor
Sponsor Name
Sponsor Organization
Sponsor Email address
Description of Sponsor’s area of expertise
Mentor Team (Please enter information of 2 or 3 of your mentors)
Note: The mentor list is not required at this time. If you have existing mentors you plan to work with, please list them here. If you do not have mentors at the time of application, additional mentors will be identified upon selection into the program
Name
Organization
Email
Area of Expertise
Name (1)
Organization (1)
Email (1)
Area(s) of Expertise (1)
Name (2)
Organization (2)
Email (2)
Area(s) of Expertise (2)
Name (3)
Organization (3)
Email (3)
Area(s) of Expertise (3)
Education (Enter 4 recent, with the most recent first)
Institution and Location
Degree Awarded
Completion Year
Field of Study
Institution and Location 1
Degree Awarded 1
Completion year 1
Field of study 1
Institution and Location 2
Degree Awarded 2
Completion year 2
Field of study 2
Institution and Location 3
Degree Awarded 3
Completion year 3
Field of study 3
Institution and Location 4
Degree Awarded 4
Completion year 4
Field of study 4
Education
Applicants Statements
APPLICANT’S BACKGROUND AND EXPERIENCE. Describe your professional and academic record, prior training, and experience to explain why you to seek this training (250-500 Words)
PROBLEM STATEMENT • For All Applicants: • Provide a statement and justification of the problems/needs that will be addressed by this training and what impact you can have to address these problems/needs • Explain the importance of a problem, need, or a critical barrier to progress that the proposed training addresses. • For PI Track Only: • Describe the strengths and weaknesses in the rigor of prior research (both published and unpublished) that justifies the need for the proposed training and research project. • Explain how the proposed training and research project will improve scientific knowledge, technical capability, and clinical practice in one or more broad cancer fields. (250-500 Words)
TRAINING PLAN. Please include ancillary coursework, meeting attendance, site visits or exchange, and project concept that will be undertaken during training (to be fully developed and refined during the training period). Also, include the following: • For all applicants: • Describe the features of the training program that will lead to a successful research career • Timeline of activities • For PI Track Only: Describe the concepts, methods, technologies, treatments, services, or preventative interventions proposed in your project and how they will lead to future career objectives. If the candidate is proposing to gain experience in a clinical trial as part of his or her research training, describe the relationship of the proposed research project to the clinical trial. Note that clinical trials themselves will not be supported through this mechanism. (250-500 Words)
Attach Biosketch
Biosketch
One file only. 256 MB limit. Allowed types: , pdf.
Institutional Support Letter
Institutional support
One file only. 256 MB limit. Allowed types: pdf, docx.
Letter from Sponsor
Sponsor letter
One file only. 256 MB limit. Allowed types: pdf, docx.
I certify that the Information provided is accurate to the best of my knowledge
Signature
Date