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Year-Off Training Program for Graduate or Medical Students
Program Application
OMB No. 0925-0299
Expiration Date 8/31/2009
Respondent Burden

Instructions: Before you begin, you may want to review some helpful hints on using electronic forms and a statement about privacy. After you fill out the application form below, press the [Preview] button at the bottom of the page and review your application for accuracy.

You are encouraged to contact investigators by e-mail or phone if you have an interest in working in their laboratories. Before you do so, we encourage you to review the various research programs at the NIH by visiting
http://www1.od.nih.gov/oir/sourcebook/sci-prgms/sci-prgms-toc.htm.


Eligibility Criteria:

  1. Candidates must have graduated from a fully accredited U.S. College or University.
  2. Candidates must be U.S. citizens or permanent residents.
  3. Candidates must have permission from their institution to interrupt their current education, with the understanding that they will return to their degree granting institution within one year.
Required Field Indicates a required field!
 
1. Personal Information
Name:
 Required Field

First MI Last
 Month/ Day of Birth: /  Required Field (mm/dd)
E-mail Address:  Required Field  Format: user@server.com
To obtain a free e-mail address, click here
 
Permanent:  Required Field
City:  Required Field
State:  Required Field  (DC for Washington D.C.)
Permanent Zip Code:  Required Field
Permanent Home Phone:  Required Field  Format: (999) 999-9999
Current Home Phone:  Required Field  Format: (999) 999-9999
Citizenship Status:  Required Field
If Permanent Resident:  
Country of Citizenship Alien Registration No.
 
2. Academic Information
 School Name:  Required Field
 Required Field
School Grading Scale:  Required Field
  Note: If you select 'Other', please explain in Section 3, Coursework and Grades. Be sure to describe your school's grading scale and your current cumulative average relative to that scale.
 Required Field
 
3. Coursework and Grades
  Course Title                                                 Grade
 Required Field
 
4. CV/ResumeYou may copy and paste your curriculum vitae into this space. Minor reformatting may be necessary.
  Include education, relevant research experience, scientific publications, honors and awards, etc.
 Required Field
 
5. References
Letters of recommendation will be expected from ...
Reference 1 (Name, Address, Phone, Email):
Name:
 Required Field
First
 MI
 Last
 Address:   Required Field
 Phone:  Required Field
 E-mail:  Required Field Format: user@server.com
Once your application is complete, an e-mail will be automatically sent to this reference requesting an online letter of recommendation.
 
Reference 2 (Name, Address, Phone, Email):
Name:
 Required Field
First
 MI
 Last
 Address:   Required Field
 Phone:  Required Field
 E-mail:  Required Field Format: user@server.com
Once your application is complete, an e-mail will be automatically sent to this reference requesting an online letter of recommendation.
 
Reference 3 (Name, Address, Phone, Email):
Name:
 Required Field
First
 MI
 Last
 Address:   Required Field
 Phone:  Required Field
 E-mail:  Required Field Format: user@server.com
Once your application is complete, an e-mail will be automatically sent to this reference requesting an online letter of recommendation.
 
 
 6. Cover Letter:
 Include your research interests, career goals, and reasons for applying for training at the NIH.
 Required Field
 
7. Areas of Scientific Interest:
1.
2.
3.
 
8. Medical Entity/Disease:
1.
2.
3.
 
9. I would like to be considered for the following Institute/Center:
 How did you hear about this program? (Please select all that apply.)
 
Notice to all applicants:
Students are advised to ensure that all application information is accurate. 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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