First Name
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Last Name
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Credentials (e.g., MD)
* must provide value
Email Address
* must provide value
Phone Number
* must provide value
Title(s) and Institution(s) (e.g., Instructor in Medicine, HMS)
* must provide value
Will there be a secondary faculty mentor involved with the project?
* must provide value
Yes
No
Secondary Mentor First Name
* must provide value
Secondary Mentor Last Name
* must provide value
Secondary Mentor Credentials (e.g., MD)
* must provide value
Secondary Mentor Email
* must provide value
Secondary Mentor Phone Number
Secondary Mentor Title(s) and Institution(s) (e.g., Instructor in Medicine, HMS)
* must provide value
Can you commit to both a project and mentor/mentee relationship that will require a hybrid work schedule* for the 8-week duration of the program?
*Given evolving public health guidelines and MGB policies, some portion of the internship will be in-person. Please come up with a mutually agreed-upon schedule at the program's start.
* must provide value
Yes
No
What are some of the mechanisms currently in place in your laboratory that help ensure a meaningful and robust research experience despite ongoing social distancing measures (e.g., video teleconferencing for lab meetings, real-time messaging platforms such as Slack or Microsoft Teams, virtual journal clubs)? (1-2 sentences)
* must provide value
Would you be willing to commit to regular recurring mentorship meetings over Zoom, Skype, or Slack?
* must provide value
Yes
No
What is the primary focus of your lab? (1-2 sentences)
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Are you interested in having more than 1 student intern? (If so, please make sure to note what each student's role would be in the next question.)
* must provide value
Yes
No
If selected, what project and role do you foresee for a potential COVID Corps intern? (1-2 paragraphs)
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Will the student need access to EPIC?
* must provide value
Yes
No
Please select the level(s) of importance it is for your intern to be proficient in the following computational skill: R Programming
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following computational skill: Python programming
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following computational skill: SAS programming
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following laboratory skill: DNA/RNA extraction
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following laboratory skill: Flow cytometry
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following laboratory skill: Gel electrophoresis
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following laboratory skill: PCR
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following laboratory skill: Plasmid preparation
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following organizational skill: EndNote
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following organizational skill: EPIC
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following organizational skill: Microsoft Office (Word, Excel, etc.)
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following organizational skill: Microsoft Access
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following skill: Data entry
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following skill: Literature review
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following skill: Medical translation
* must provide value
Please select the level(s) of importance it is for your intern to be proficient in the following skill: Patient interview
* must provide value
Please list any additional skills you would be looking for with your potential intern.
* must provide value
What is the IRB number for your research project?
* must provide value
If mutually agreeable to the intern and the mentor, could the remote internship extend part-time (e.g., 10 hrs/wk) into the academic year?
* must provide value
Yes
No
The COVID Corps team is willing to perform the initial vetting to match compatible mentors and interns. We also want to respect the need to ensure a good fit. Would you prefer to have the opportunity to rank your top 4 candidates out of a curated shortlist?
* must provide value
Yes
No
While the MGH COVID Corps program offers interns a summer stipend (totaling $3,000), the program's reach may be furthered if investigators were in a position to support their own trainees. Do you have research funding available to provide a stipend? (Please note: Support must come from research funds and not sundry.)
* must provide value
Yes - I have funding to provide the full ($3000) stipend.
Yes - I have funding to provide half ($1500) of the stipend.
No - I do not have funding available to provide a stipend.
Unsure
Please clarify why you are unsure of whether you will be able to provide funding, and whether you'd potentially be able to provide full or half the funding.
* must provide value
Please provide your fund number/cost center.
* must provide value
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