Responsible Conduct of Research RCR Credit Request for Supplemental Instruction

Form to Request RCR Credit for

Supplemental Instruction

Use this form to request credit towards a Responsible Conduct of Research (RCR) certificate for relevant instruction that you received from a faculty mentor on a one-on-one or small group basis (e.g., within the context of a lab meeting).

This form should be completed by the student, postdoc, or trainee who is seeking credit towards a Responsible Conduct of Research Certificate. If you have questions about completing this form, please contact the Responsible Conduct of Research Program at Research-Training@email.arizona.edu or call 520-626-8757.

NOTE 1:

The total number of hours of one-on-one and small group RCR-related instruction a graduate student, postdoc, or trainee receives from faculty mentor(s) in the course of their time at UA will hopefully exceed the minimum NIH and NSF requirements. However, only three (3) hours of this supplemental instruction may count towards the NSF and/or NIH RCR Certificates. The reason for this restriction is to foster engagement with RCR topics in a variety of contexts and in cross-disciplinary settings.

NOTE 2:

In order to guarantee that a given subject was addressed in sufficient depth, a minimum of 1 hour of total instruction must have occurred about a particular topic to request RCR credit. Instruction need not have occurred all at one time. For example, you and your advisor discuss your plan for managing and securing the research data your project will generate. This conversation takes place over the course of three separate 30-minute meetings. You would then use this form to claim 90 minutes of instruction on data management.

STUDENT/POSTDOC/TRAINEE INFORMATION

First Name *

Last Name *

UA Email Address *

Net ID *

Department *

Towards which RCR certificate would you like this instruction to count? (Select all that apply) *

NSF RCR Certificate NIH RCR Certificate

DESCRIPTION OF INSTRUCTION

Please describe what was covered in your instruction by completing one section for each subject. If just one subject was covered, you only need to complete one section!

SUBJECT #1

Subject Matter #1 (please choose the subject that most closely describes what was covered) *

Nature of the instruction (check all that apply) *

One-on-One Small Group

Name of Faculty Mentor (who provided the instruction) *

Faculty Email Address *

Please note: the faculty member you enter here will be contacted to verify that the instruction took place.

Please describe in 2-3 sentences what specifically was covered about this subject. *

For the next field, please be as specific as possible. (For example: My advisor and I discussed x topic for 15 minutes every week for 4 weeks during our regular meeting, from 3/3/15-3/24/15)

Date(s) on which instruction occurred *

For the next field, please enter the total amount of time spent on the subject. However, note that in order to ensure that a variety of RCR subjects are addressed, no more than 90 minutes of instruction on any given subject may count towards the RCR certificate.

Total duration of instruction on subject matter #1 *

SUBJECT #2 (complete only if a second subject was addressed)

Subject Matter #2 (please choose the subject that most closely matches what was covered)

Nature of the instruction (check all that apply)

One-on-One Small Group

Name of Faculty Mentor (who provided the instruction)

Faculty Email Address

Please describe in 2-3 sentences what specifically was covered about this subject.

For the next field, please be as specific as possible. (For example: My advisor and I discussed x topic for 15 minutes every week for 4 weeks during our regular meeting, from 3/3/15-3/24/15)

Date(s) on which instruction occurred

For the next field, please enter the total amount of time spent on the subject. However, note that in order to ensure that a variety of RCR subjects are addressed, no more than 90 minutes of instruction on any given subject may count towards the RCR certificate.

Total duration of instruction on subject matter #2

SUBJECT #3 (complete only if a third subject was addressed)

Subject Matter #3 (please choose the subject that most closely matches what was covered)

Nature of the instruction (check all that apply)

One-on-One Small Group

Name of Faculty Mentor (who provided the instruction)

Faculty Email Address

Please describe in 2-3 sentences what specifically was covered about this subject.

For the next field, please be as specific as possible. (For example: My advisor and I discussed x topic for 15 minutes every week for 4 weeks during our regular meeting, from 3/3/15-3/24/15)

Date(s) on which instruction occurred

For the next field, please enter the total amount of time spent on the subject. However, note that in order to ensure that a variety of RCR subjects are addressed, no more than 90 minutes of instruction on any given subject may count towards the RCR certificate.

Total duration of instruction on subject matter #3