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Date this form completed PERSONAL DATA Last Name First Name Middle Initial Permanent Address: City State Zip Code Mobile Telephone Work Telephone E-mail Address Place of Birth Date of Birth Country of Citizenship If not US, what is your visa status: Permanent Resident J1: H1: Other: Issue Date: Expiration Date: EDUCATION College Medical School Graduate School NAME OF INSTITUTION LOCATION DATES OF ATTENDANCE DEGREE AWARDED Current Position Nominating Chairperson Clinical

Material from Rape Victim Advocacy Program (www.rvap.org) ©2005 Let the survivor take the lead in her/his own recovery. Right now the survivor needs to be in control of her/his own actions. Regardless of how sincere you are, behavior that is pushy or coercive will not be helpful to the survivor. If the survivor wants to talk, be open to listening and if you aren’t comfortable listening, help to find someone who can listen. If the survivor doesn’t want to talk, don’t try to

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JULY 29, 2024 PRESENTED BY: ALINA GRAYS ASSISTANT DIRECTOR, SPA EDUCATION & BUSINESS PROCESS SPA CERTIFICATION PROGRAM Proposed Syllabus Confidential FY25 Session Overview • Application process: Application opens May 1, 2024 and are due July 19, 2024. Application review and acceptance notifications will be sent Friday, August 9, 2024. • Cohort groups: Accepted applicants will be placed in one of two Cohort sections. • What do

Research Roundup: Deadline Reminders Office of Business Affairs Sponsored Programs Administration – Paving the Way to Discovery Novel Artificial Intelligence Approaches to Advance Cardiovascular and Cerebrovascular/Brain Health LOI due: February 27,2025 (3:00 PM CST) Application due: May 1, 2025 (3:00 PM CST) 14-day deadline: April 17, 2025 P Series All-new, renewal, resubmission, revisions Application due: May 25, 2025 (5:00 PM CST) 14-day deadline: May 11, 2025 Due to the

Office of the Registrar 5323 Harry Hines Blvd. Dallas, Texas 75390-9096 (214) 648-3606 Phone stuinfo@utsouthwestern.edu Number of Transcripts Requested NOTE: IF REQUESTING MORE THAN 5 TO BE SENT TO DIFFERENT ADDRESSES, MAILING LABELS MUST BE PROVIDED. SPECIAL INSTRUCTIONS * PLEASE FILL OUT COMPLETELY WITH SIGNATURE* E-MAIL COMPLETED FORMS TO STUINFO@UTSouthwestern.edu • There is no charge for sending a verification. • Transcripts will not be faxed from out office. With few exceptions, you

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Medical Student Research for Project Description Form All descriptions must contain enough detail to permit an assessment of the problem that is to be addressed and the methodologies that are to be employed. Please be careful to outline the role that the student will play in the project that is described. Please ensure that all relevant approval numbers (IRB, IACUC) are provided. Mentor: Department: Room number: Phone number: E-mail: Research Coordinator: Project title: Human

Obesity Alliance Conferences 2007 The UT Southwestern Obesity Alliance's weekly conferences on metabolism, nutrition, and obesity are held at noon on Thursdays (Y6.224). The conferences are sponsored by the Task Force for Obesity Research (TORS). December 27, 2007- rescheduled October 25, 2007 Vinaya Simha, M.D. "Metabolic Consequences of Bariatric Surgery." October 18, 2007 Jeffrey Zigman, MD, PhD Ghrelin and motived behaviors. October 11, 2007 Mark Drazner, MD

Timeline Calendar Grant Submission Timeline: Start at red arrow Due Date: Task: 18 Day Tuesday, April 12, 2022 Draft of All non-science Documents 14 Day Saturday, April 16, 2022 Draft of All non-science to SPA 7 Day Saturday, April 23, 2022 FINAL of All Documents 4 Day Tuesday, April 26, 2022 LAST DAY TO SUBMIT TO SPA Enter Due Date Here Due Date Saturday, April 30, 2022 SUBMISSION TO SPONSOR PI: Sponsor: Grant Type/Title: Version Control Document Title