Scholarship Application 2021 Clinical Research Professional Certification Exam Scholarship Division of Research Operations and Services (DROS) in partnership with the UF CTSI Clinical Research Professionals Advisory Council (CrPAC) Name(Required) First Last Email(Required) Working title(Required) Official title(Required) Division/Dept/Institute CollegeCALS/IFASDentistryCLASEngineeringFSUHealth and Human PerformanceJournalism and CommsNursingPharmacyPHHPMedicineVeterinary MedicinePrimary Investigator Highest degree earned/or in progress(Required) Certifications (research-related) Other certifications Total years in research(Required)Have you held research roles with other employers?(Required) Yes No Years in research at UFYears in human subjects research(if different than above)Previous roles you have held in research at UF (list all types of roles, the order is not relevant)Previous roles you have held in human subjects research (if different from above; list all types of roles)Have you discussed certification with your supervisor?(Required) Yes No What is the greatest barrier for certification (per your supervisor)? Check ALL that apply Time commitment Unfamiliarity with certification Don't understand value Financial barrier Please select the following job functions that you CURRENTLY perform in your role:(Required) Document adverse events Prepare or review documents submitted to the IRB Protocol review or study procedures planning Participate in conducting subject visits Maintain source documents Prepare for and participate in study visits with monitor, sponsor, auditors, etc. Participate in consent process What are you interested in pursuing?(Required) Certification Membership Both Which certification would you like to pursue? ACRP (CP, CRC, CRA, CPI, Device, PM) SoCRA (CCRP) Other If you select "Other," please note which organization provides the certification and the certification's name.Have you previously participated in a study group at UF that included preparing for the certification you noted above?(Required) No Yes Please list year and semester of study group How did you hear about these certifications? Upload application documentsCurrent CV & job description(Required) Drop files here or Select files Max. file size: 125 MB. Please upload your CV as well as a current job description, if not included in your CV.Letter of support from your immediate supervisor or PI(Required)Max. file size: 125 MB.500-word personal statement(Required)Max. file size: 125 MB.Please answer these questions: 1 - Why do you believe it is important to hold a research-related certification? 2 - Why do you WANT to hold a research-related certification? 3 - What is the impact you hope to bring to the UF research community with the gain of this certification?