Research FellowshipFREDERICK A. COLLER SURGICAL SOCIETY APPLICATION FOR RESEARCH FELLOWSHIP Research Fellowships are intended to promote the conduct of a specified research project by supporting the goods or services consumed in the acquisition of data. See below for a list of allowed and unallowed expenses: Publication expenses allowed. Payment for consumables such as animals, reagents, lab supplies, database acquisition or database use fees all permitted. Detailed budget required to validate the nature, amount and price of consumables to assure expenditures are reasonable for what is purchased and that the materiel is applicable to the project which has been approved. Salary of technical help or fees for technical work done in cores permitted. Budget required. Fees for work done within scientific cores (ie DNA sequencing, flow cytometry, electron microscopy etc.) permitted. Budget required. Travel to professional meetings for presentation of results permitted if the Coller scholar is first author on work being presented. No travel outside of US permitted. No travel expenses permitted if Coller scholar not first author. Payment of resident salary expenses, direct salary or benefits, would not be permitted. Payment of facility rent not permitted. Payment of indirect costs not permitted. Educational or surgical aids that will become the property of the scholar (textbooks, subscriptions, computers, laptops, tablets, loupes, etc.) not permitted. TO THE COUNCIL OF THE FREDERICK A. COLLER SURGICAL SOCIETYI hereby make application for a Frederick A. Coller Surgical Research Fellowship. 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Yes NoIf a Naturalized Citizen, state where and when you were NaturalizedColler Society Sponsor Member NameI SUBMIT THE FOLLOWING DATA CONCERNING MY MEDICAL EDUCATION AND SURGICAL TRAININGPremedical educationUniversity or CollegeMonth/YearMonth/YearDegreeMedical educationUniversity or CollegeMonth/YearMonth/YearDegreeTraining following InternshipResidencyMonth/YearMonth/YearFellowshipMonth/YearMonth/YearResearch ExperienceOther Professional ExperiencePlease attach your Bibliography (PDF format only)Choose File Please attach your research project description for the Research Fellowship year (PDF format only)Choose File Download the following form and attach below with your on-site sponsor signature. On Site Sponsor FormPlease attach your on-site sponsor formChoose File Please include sponsorship letter from a Coller Society MemberChoose File Applicant SignatureDate of ApplicationSubmit Form