Technical Assistance Workshop Registration

Grants Technical Assistance Workshop: A Workshop for Minority & Emerging Scientists and Students Seeking Careers in Aging Research

Privacy Act Notification Statement

Collection of this information is authorized under 42 U.S.C. 241. The primary use of this information is to 1) identify candidates for clinical and research fellow, clinical elective, and other training positions, and 2) maintain a permanent record for historical and reference use of those individuals who have received clinical research training at the National Institutes of Health. This information may be disclosed to researchers for research training purposes, to hospitals and other healthcare institutions seeking verification of training for physicians who trained in NIH clinical programs and in response to Congressional inquiries. Submission of this information is voluntary, however, in order for us to accept you as a potential Clinical and Research Fellow, Dental/Medical Student, Postbac/Postdoc Researcher, Summer Intern, or other student seeking an opportunity in an NIH training program, you should complete all fields.

2008 Grants Technical Assistance Workshop

November 20 & 21
National Harbor, Washington, DC

Application Deadline:
July 18, 2008

NOTE:
Please ensure that you receive an automated confirmation email stating that your submission was successfully received. If you have submitted your application, but have not received this confirmation, please contact Dr J. Taylor Harden at 301.496-0765 or hardent@nia.nih.gov. Thanks for your interest in the Grants Technical Assistance Workshop.

Please fill in the information below (* required):

First Name*: Middle Initial:
Last Name*:
Degree*:
Discipline*:
Ethnicity:
Research Interests (sub-discipline, research area; use no more than 10 words)*:

Office Mailing Address:
Institution*:
Department:
Street Address Line 1*:
Street Address Line 2:
City*: State*:
Zip/Postal Code*:

Home Mailing Address:
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Street Address Line 2:
City : State:
Zip/Postal Code:

Home Phone: Work Phone:
Fax Number:

E-Mail Address*: E-Mail Address (confirm)*:

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Home Address
Office Address

During September, I can be reached at a different mailing address and telphone number:
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Number of years research experience*:
less than 1
1-3
more than 3

Please add my name to the mailing list*:
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Submit Supplemental Materials (Word or PDF format):

1. Curriculum vita/resume* :

2. One page applicant abstract* (Required format: one page with 1/2 inch margins all around and to include: Title centered on the first line, Name of Presenter, University Affiliation, Background of the problem, Specific Aims/Questions, Hypothesis(es), Methodology, General Design, Subjects, Instrumentation/measurements, and Analysis Plans):

Page last updated Apr 29, 2008