Vanderbilt University
Institute of Imaging Science
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VUIIS Entry Form

Welcome to VUIIS! Within this form are details covering all aspects to get you started here at VUIIS including obtaining details to be submitted to appropriate people to gain access to the building, computer systems, newsletter lists, website, training etc. Please fill it out in its entirety and contact Tracy Wilson if you have any questions. It will take 5-20 minutes of your time to complete.

General Administration

First Name:*
Last Name:*
VUnetID:
Email:
What is your position at VUIIS:*
Graduate Student
Post Doctorate
Staff
Visiting Scholar
Undergraduate Staff
Mentor/Faculty Member First Name:
Mentor/Faculty Member Last Name:
Paid     Unpaid
Start date:*
Expected end date:
Mentor First Name:
Mentor Last Name:
Current Primary Institution:
Current Research Focus:
Have you completed a degree?
Yes     No
What is your highest degree completed?
Institution where degree was completed:
Focus of previous degree:
Year completed (YYYY):
Academic Credit     Unpaid
Start date:*
Expected end date:
Faculty Member First Name:
Faculty Member Last Name:
Current Primary Institution:
Current Research Focus:
Date of Birth: (MM/DD/YYYY)
Address:
City:
Zip:
Do you have an office location?
Yes     No
Office Location:
Do you have an office phone number?
Yes     No
Office Phone Number:

Card Access:

CSAI
Human Imaging
Computer Lab




Graduate Student Details

Sex:*
Female
Male
Current Academic Home Department:
Current title at VUIIS:
Current start date at VUIIS:
Current end date at VUIIS:
Current mentor's first name:
Current mentor's last name:
Current mentor's email:

Trainee's mentor core faculty of VUIIS, affiliated faculty of VUIIS, or other?
VUIIS Faculty
VUIIS Affiliated Faculty
Other
Do you have another mentor?
Yes No
Second mentor's first name:
Second mentor's last name:
Second mentor's Email:
Second mentor core faculty of VUIIS, affiliated faculty of VUIIS, or other?
VUIIS Faculty
VUIIS Affiliated Faculty
Other
Current title or research area:
Name of your previous institution:
Degree completed at previous institution:
Date previous education completed:
Previous general research focus:
Previous program/department:
Have you been or are you currently on a training grant?
Yes No
Which training grant?
T32 PreDoc: MRI techniques
R25 PreDoc: Cancer Imaging
Date started training grant:
Date training grant ended:


Post Doctoral Details

Sex:*
Female
Male
Current Academic Home Department:
Current title at VUIIS:
Current start date at VUIIS:
Current end date at VUIIS:
Current mentor's first name:
Current mentor's last name:
Current Faculty Mentor Email:

Trainee's mentor core faculty of VUIIS, affiliated faculty of VUIIS, or other?
VUIIS Faculty
VUIIS Affiliated Faculty
Other
Do you have another Faculty Mentor?
Yes No
Second mentor's first name:
Second mentor's last name:
Second Faculty Mentor Email:
Second mentor core faculty of VUIIS, affiliated faculty of VUIIS, or other?
VUIIS Faculty
VUIIS Affiliated Faculty
Other
Current dissertation title or research area:
Name of your previous institution:
First name of your previous mentor:
Last name of your previous mentor:
Previous dissertation title:
Degree completed at previous institution:
Previous date education complete:
Previous general research focus/area:
Previous program/department:

Training Requirements

Please answer the following questions on areas relevant to you. The information needed for training will be displayed here and emailed to you upon completion.

Will you require access to the chemistry lab?*
Yes     No
Will you be in contact with the radiation facility?*
Yes     No
Will you be conducting human research?*
Yes     No
  • Please ask your mentor for specific modules you are to be trained in. It is imperative, however, that you complete this training before starting your research! IRB training
  • Will you require use of the MRI Human Scanners?*
    Yes     No
    Will you be conducting animal research?*
    Yes     No
  • Please ask your mentor for specific modules you are to be trained in. It is imperative, however, that you complete this training before starting your research! IACUC training
  • Will you require use of the MRI Animal Scanners?*
    Yes     No


    Additionally, all trainees, graduate and post doctoral fellows are required to participate in Responsible Conduct of Research (RCR). The BRET office offers a 1 day training program that all trainees are required to attend which is both didactic and discussion-based and covers the nine areas specified by the Office of Research Integrity, during the first year at Vanderbilt. This training session is given annually in May and you will be contacted with the details of date, location and registration via email correspondence and VUIIS newsletter announcements. For more information go to BRET-RCR.

    Website Information

    Name as it should appear on the website.
    First Name:*
    Last Name:*
    Credentials (optional):
    Please list your title(s), separated by commas, as you would like seen on the website:*
    For Faculty and Trainees, please describe your area of focus within 1/2 sentences in a first person casual manner.*

    For staff, if you are unsure please write about what you like about working at VUIIS in the same tense as described above.
    Describe your Current Research Projects:*

    For staff if you do not have research projects to outline, please describe what you do at VUIIS. (Please keep word count between 50-200)
    List your Featured Publications.
    Publication 1:
    Publication 2:
    Publication 3:
    Publication 4:
    Publication 5:
    Additional Comments: