Research Publication Award Application

Students are required to ensure that the chosen journal is reputable and not a predatory publisher. Journals should be indexed publications and, preferably, listed on PubMed. If not, students should include justification for the journal they have chosen. The maximum award is $1500 per student per year during their medical school career, depending on availability of funds. Funds are awarded on a first come, first serve basis. An applicant may petition the committee for a higher amount if funds are available.

Please email a copy of your manuscript to msrp@usd.edu.

Today's Date

Applicant Information

First Name

Last Name

Email

Phone Number

Year In Medical School

Mentor Information

Mentor's First Name

Mentor's Last Name

Mentor's Email

Mentor's Phone

Specialty, department or field

Academic Rank

Research Project Description

Project Title

Project Funding Source

Describe alternate sources of funding that you've applied for

Publication

Has your paper been accepted for publishing? Yes No Pending

Order of Authors

Article Title

Journal Name

Publication Cost

Date Payment is Due

Comments

Confirmation and Agreement

Confirmation

By checking this box, I confirm that I have discussed this publication submission with my mentor(s) and have their support.

Applicant Demographic Information (Optional)

Citizenship

Sex

Do You Have a Disability

Date of Birth

Race / Ethnicity

Research Publication Award Application

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