Dear Applicant, Thank you for your interest in the Monica McLemore CRC Certification Scholarship. In collaboration with UCSF's Anchor Institution Mission (AIM) workforce development team and UCSF's Research Action Group for Equity (RAGE), we would like to congratulate you for taking the time to apply. This scholarship is our effort to support the development and upward mobility of our incredible clinical research coordinators. Your application will be reviewed by a committee and the committee will meet to select the scholarship awardees. Thank you for making research possible at UCSF; your efforts contribute to making UCSF a worldwide renowned institution!
The scholarship is funded by UCSF's AIM workforce development team and RAGE.
If you have questions, please contact Alexandra at Alexandra.Velasquez@ucsf.edu
First Name
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Last Name
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Email Address
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Phone Number:
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ex: (415) 555-1212
Undergraduate Institution
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Undergraduate Major
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What department/division do you work in? Please be as specific as possible.
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What is your job title?
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Assistant Clinical Research Coordinator
Clinical Research Coordinator
Senior Clinical Research Coordinator
Other job title above Sr. CRC
Please indicate your job title above Sr. CRC
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How long have you worked in this position at UCSF?
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0 -1 years
1 - 3 years
3- 5 years
5+ years
How long have you worked at UCSF?
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0 -1 years
1 - 3 years
3- 5 years
5+ years
Please indicate your primary campus.
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Parnassus
Mount Zion
ZSFG
Other
Email for your PI/PIs
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Email for your supervisor/supervisors
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Name of your Division Chief or Chair
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What type(s) of studies do you work on? (please select all that apply)
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Please Specify
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Describe your research project(s) in 3-4 sentences.
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In your current role, are you responsible for any of the following research activities? (please select all that apply)
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Please list any other relevant responsibilities here
Do you want to be SoCRA (Society of Clinical Research Associates) or ACRP (Association of Clinical Research Professionals) certified? Please note the scholarship is to become SoCRA certified.
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Yes
No
Please select which certification you would like to be certified as?
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SoCRA
ACRP
To be eligible to become SoCRA certified, you must fit into one of the following categories. Please indicate your eligibility category (https://www.socra.org/certification/ccrp-certification-exam/candidate-eligibility/) . Per SoCRA:
The applicant must be working with Good Clinical Practice (GCP) guidelines under IRB/IEC/REB-approved (or specifically exempted) protocols.
The applicant must meet one of the following Eligibility Criteria noted below. Please note that most candidates will be eligible under Category 1.
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Category 1: Applicant must have (and be able to document) ALL of the following qualifications: Have two years of experience as a full-time Clinical Research Professional (or have 3,500 hours part-time) during the last five years. Please note: If you have completed two (2) years of full-time employment as a clinical research professional in the past five years, you will NOT need to provide supporting documentation for your educational experience.
Category 2: Applicant must have (and be able to document) ALL of the following qualifications: Hold a degree in "Clinical Research conducted with humans according to the principles of Good Clinical Practice GCP" from an Associate, Undergraduate, or Graduate Degree Program AND Have completed a minimum of one year of full-time experience (or 1,750 hours part-time) during the past two years as a Clinical Research Professional
Category 3:Applicant must have (and be able to document) ALL of the following qualifications: Hold an Undergraduate or Graduate Certificate in "Clinical Research conducted with humans according to the principles of Good Clinical Practice GCP" with a curriculum of no less than 12 semester (credit) hours or totaling a minimum of 144 credit hours from an academic institution of higher learning (community college, college or university) AND Hold an Associate's or Bachelor's Degree in a science, health science, pharmacy or related field AND Have completed a minimum of one year of full-time experience (or 1750 hours part-time) during the past two years as a Clinical Research Professional.
The scholarship will cover the following: Computer Based Testing, CBT, (Testing Center or Home Proctoring): $115 Current Members: $395 Non-Members: $450 Please indicate if you are able to provide the following (https://www.socra.org/certification/ccrp-certification-exam/apply-online/): Signed Ethics Statement: Download, sign, date, and return the Ethics Statement with your application portfolio Resume / CV Verification of Employment Letter(s); If awarded the scholarship, you will need a letter from your supervisor or HR generalist when submitting to SoCRAJob Description(s) Category 2 applicants must ALSO include the following in their application portfolio: SOCRA Form 1011 AND All requested documentation indicated on Form 1011 Category 3 applicants must ALSO include the following in their application portfolio: SOCRA Form 1022 AND All requested documentation indicated on Form 1022
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Yes
No
Please submit in one PDF file the following:
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Please indicate your performance Evaluation Status for 2024:
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CE / Consistently exceeds all standards or goals
MA / Meets all standards or goals and, in many instances, exceeds them
M / Meets all standards or goals
Bio: Please tell us a little bit about yourself (see this as your elevator pitch)
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Please discuss the importance of having an all inclusive clinical research workforce.
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Have you discussed with your supervisor/manager/PI your interest to become SoCRA certified?
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Yes
No
PLEASE NOTE: If you are awarded the scholarship, please note that you will have 3 months from the time SoCRA approves your submission to take the test. Are you able to commit to this timeline?
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Yes
No
Race/Ethnicity
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Please Specify
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Male
Female
Prefer not to answer
Gender Identity
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Agender
Androgynous
Bigender
Cisgender
Cisgender man/male
Cisgender woman/female
Genderfluid
Genderqueer
Gender noncomforming
Non-binary
Pangender
Questioning
Transgender
Trans man/male
Trans woman/female
Two-spirit
Another
Prefer not to answer
Were you the first in your family to attend college?
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Yes
No
Prefer not to answer
Are you from a disadvantaged background?
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Yes
No
Do not know
Prefer not to answer
Submit
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