JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
ICEP Research Tracking
This form is to compile a list of ICEP research results (publications, conference, presentations, posters, awards,...) so we can track how the program has impacted your careers.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your name
Your answer
Your work email
Your answer
Your final graduate degree
MD
PhD
MD PhD (Dr. Med.)
Master
Bachelor
No graduated
Other:
I am a former ICEP participant (indicate year or years)
*
Your answer
Your year of (anticipated or completion of graduation)
Your answer
I participated in ICEP research
ICED educational research
Short-term travel
Long-term travel
Post- graduate placement
Other:
Your topic of research
Your answer
The university you are graduating from/have graduated from
*
Berlin University Charite, Berlin, Germany
Columbia University, New York, USA
Harvard University, Boston, USA
Keio University, Tokyo, Japan
King's College, London, UK
Kyoto University, Japan
Ludwig Maximilians University, Munich, Germany
Martin Luther University, Halle, Germany
McGill University, Canada
Medical University of Vienna, Austria
National Taiwan University, Taipei, Taiwan
National University of Singapore, Singapore
Seoul National University, Korea
Stanford University, Stanford, USA
The University of Sydney, Australia
Tokyo Women's Medical University, Japan
University Autonoma Madrid, Spain
University of Barcelona, Barcelona, Spain
University of California San Diego, USA
University of California San Francisco, USA
University of Cambridge, Cambridge, UK
University of Copenhagen, Denmark
University of Helsinki, Finland
University of Paris Cite, Paris, France
University of Milan, Italy
University of Nairobi, Kenya
Yale University, New Haven, USA
my school is not listed - please indicate
Other:
The university you mainly worked on the project
*
Berlin University Charite, Berlin, Germany
Columbia University, New York, USA
Harvard University, Boston, USA
Keio University, Tokyo, Japan
King's College, London, UK
Kyoto University, Japan
Ludwig Maximilians University, Munich, Germany
Martin Luther University, Halle, Germany
McGill University, Canada
Medical University of Vienna, Austria
National Taiwan University, Taipei, Taiwan
National University of Singapore, Singapore
Seoul National University, Korea
Stanford University, Stanford, USA
The University of Sydney, Australia
Tokyo Women's Medical University, Japan
University Autonoma Madrid, Spain
University of Barcelona, Barcelona, Spain
University of California San Diego, USA
University of California San Francisco, USA
University of Cambridge, Cambridge, UK
University of Copenhagen, Denmark
University of Helsinki, Finland
University of Paris Cite, or Sorbonne University , Paris, France
University of Milan, Italy
University of Nairobi, Kenya
Yale University, New Haven, USA
my school is not listed - please indicate in
Other:
If not listed
Your answer
Your current affiliation
*
Your answer
I presented at a conference (name of conference and year and location)
Your answer
I presented at a conference as
First author
Co-author
Other:
Optional - I won an award (name of the award)
Your answer
I published a paper (type in DOI or URL link)
Your answer
Your website or ORCID link or Twitter handle for applicants to look you up (optional)
Your answer
Which year did you participate in ICEP? Please note summer or fall of your participation.
*
Your answer
If you are a former ICEP participant - Did you travel during your ICEP year and where?
*
Your answer
If you school is not listed please indicate here
Your answer
Any other comments
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report