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Clinical Research Training Program
OMB No. 0925-0299
Expiration Date 8/31/2009
Respondent Burden
Program Application
Instructions: Before you begin, you may want to review some helpful hints on using this electronic form and our privacy statement.

Eligibility Criteria:

  1. This program is intended for medical and dental students. Candidates must currently be enrolled in a medical school accredited by the Liaison Committee on Medical Education (LCME), a dental school that is accredited by the Commission on Dental Accreditation, or an osteopathic school that is accredited by the American Association of Colleges of Osteopathic Medicine (AACOM).
  2. Candidates in M.D./Ph.D. programs are eligible to apply.
  3. Candidates must have completed a year of clinical rotations prior to starting the program.
  4. Candidates must be U.S. citizens or permanent residents.
Application Tips:

This form has recently been revised to allow you to save a partially completed application. To take advantage of this feature, please proceed as follows:

  • Enter as much information into the form as you would like.
  • Press "Save Partial Application & Quit" to save the information you have entered thus far, and return later to complete your application.
  • When you first submit your partial application, you will automatically receive a confirmation e-mail containing login information and instructions for accessing the online tool that allows you to review, modify, and complete your application.
Once you complete your application, press "Preview Completed Application." You will be taken to a page displaying the information you have provided. To submit your completed application, you must click the "Save" button on the Preview page.

IMPORTANT NOTE: All fields on your application must be completed by January 15, 2009 (midnight, Eastern Standard Time). Applications that are incomplete after the 1/15 deadline will not receive further consideration.

  1. Review the "Program Brochure" and "Frequently Asked Questions" before beginning your online application.
  2. Be sure that the e-mail addresses you provide for your references are accurate. Incorrect e-mail addresses will delay the processing of your application and could result in your application's not receiving full consideration.
  3. Please note that this form accepts plain text inputs only. This means that special characters and formatting such as bullets, "smart quotes," bold or italic fonts, Greek letters, etc., will be lost or altered. To ensure your data appears as you intend it to, compose your inputs to the longer fields on this form using a plain text editor (e.g., Notepad, for PC users, or TextEdit, for Mac users). In place of special formatting, you will need to rely on the use of capital letters, white space, asterisks, and other standard keyboard characters.
  4. Proofread your application thoroughly for accuracy and completeness; false or inaccurate information may be grounds for denying your candidacy or removing you from the program.
  5. Complete your application as soon as possible and encourage your references to submit their letters promptly using the electronic system.
  6. The deadline for receipt of completed applications is January 15, 2009 (midnight, Eastern Standard Time). Applications that are incomplete after the 1/15 deadline will not receive further consideration. Be sure that your letters of recommendation are submitted online by January 22.
  7. CRTP participants are required to submit an official transcript after accepting an offer to participate in the program. Transcripts should be sent to:

    Clinical Research Training Program
    Office of Clinical Research Training and Medical Education
    National Institutes of Health
    Building 10/Room 1N248
    Bethesda, MD 20892-1158
Required Field Indicates a required field!
 
1. Personal Statement
 Include your research interests, career goals, and reasons for applying for the CRTP.
  Required Field 
(Limit: 10,000 characters)  characters left
 Required Field  (Limit: 100 characters)
 
2. Personal Information - Minimally Required
 Required Field

 Required Field     Format: user@server.com 
To obtain a free e-mail address, click here
 Required Field
 Required Field  Format: (999) 999-9999
   Personal Information
 Required Field
 Required Field
 Required Field  (DC for Washington D.C.)
 
 
 Required Field  Format: (999) 999-9999
 Required Field  Format: (999) 999-9999
 Required Field
If Permanent Resident:  
Country of Citizenship Alien Registration No.
 
3. Academic Information
School Name: (Select pick one school from the appropriate list) Required Field





School Grading Scale:  Required Field
   Required Field
All 4th year applicants who are selected to participate in the CRTP must make arrangements with their medical, dental, or osteopathic school to defer graduation until after completing the CRTP fellowship. This requirement must be met prior to starting the CRTP at NIH.
 
4. Coursework and Grades (List only your medical/dental school grades)
For Core Rotations, please indicate (1) date completed; and (2) grade pending, if applicable

If accepted to participate in the CRTP, fellows are required to submit an official medical, dental, or osteopathic school transcript. The grades entered into the electronic application are for evaluation purposes only.

 Course Title                                                       Grade
 Required Field 
As you receive grades for courses that you are currently taking or grades that are pending, please add those grades to your application. You will be able to modify your application until the application deadline, January 16th.

If accepted to participate in the CRTP, fellows are required to submit an official medical, dental, or osteopathic school transcript. The grades entered into the electronic application are for evaluation purposes only.
 
5. CV/Resume
Copy and paste a plain text version of your curriculum vitae into this space. Minor reformatting may be necessary. Include education, relevant research experience, scientific publications, honors and awards, etc.
 Required Field 
 
6. Reference
Reference 1:
Please provide contact information for the Dean of Student Affairs, who must provide a supporting letter of recommendation that indicates your student status and also approval of your participation in the CRTP.
Name:
 Required Field
First
 MI
 Last
Address:   Required Field
Phone:  Required Field
E-mail:  Required Field Format: user@server.com
 
Reference 2:
Name:
 Required Field
First
 MI
 Last
 Address:   Required Field
 Phone:  Required Field
 E-mail:  Required Field Format: user@server.com
 
Reference 3:
Name:
 Required Field
First
 MI
 Last
 Address:   Required Field
 Phone:  Required Field
 E-mail:  Required Field Format: user@server.com
 
 How did you hear about this program? (Please select all that apply.)
 
Notice to all applicants:
It is your responsibility to ensure that all of the above information is correct. False or inaccurate information contained in this application may be grounds for denying your candidacy or removing you from the program.
 
 
 
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