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Postbaccalaureate IRTA Program

Program Application

OMB No. 0925-0299
Expiration Date 8/31/2009
Respondent Burden

If you have already applied to the NIH Academy program and would also like to apply to the Postbaccalaureate IRTA, do not use the form below; instead, click here to apply using your NIH Academy application.

Instructions:

Before you begin, you may want to review some helpful hints on using this electronic form and our privacy statement.

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: Only completed applications are available for review by NIH investigators and administrators; partial applications cannot be accessed by NIH investigators.

Tips for Applying Successfully:

Review the NIH Academy program description and "Frequently Asked Questions" before beginning your online application.
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.
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.
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.
Complete your application as soon as possible and encourage your references to submit their letters promptly using our online system. If you are applying to the NIH Academy, you must complete all fields on your application by January 31, 2009 (midnight, Eastern Standard Time). Applications that are incomplete after the 1/31 deadline will not receive further consideration by the NIH Academy selection committee. Also, letters of recommendation supporting NIH Academy applications must be received ON or BEFORE March 1, 2009.

Eligibility Criteria:

Candidates must be U.S. citizens or permanent residents and intend to apply to graduate or medical school within the next year.
Candidates for the Postbaccalaureate IRTA Program must have graduated from a fully accredited U.S. College or University no more than 2 years prior to the activation date of traineeship.
Candidates for the NIH Academy Program must have graduated with their first Bachelor’s degree from a fully accredited U.S. College or University no more than 1 year prior to the activation date of traineeship. In other words, individuals generally must apply during their senior year.

Indicates a required field!

1. Personal Information - Minimally Required

Name:


	First	MI	Last

Month/ Day of Birth:

(mm/dd)

E-mail Address:

Format: user@server.com
To obtain a free e-mail address, click here

Preferred Telephone Number:

Format: (999) 999-9999

Personal Information

Permanent Address:

City:

State:

(DC for Washington D.C.)

Permanent Zip Code:

Permanent Home Phone:

Format: (999) 999-9999

Citizenship Status:

If Permanent Resident:

Country of Citizenship	Alien Registration No.

2. Academic Information

Current School (or last school attended):
Current Cumulative GPA:
School Grading Scale:
	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.
Academic Major:	or
Degree Type:
Month and Year Degree Received/Expected:	/ (mm/yyyy)
Education Plans:	or
	Note: Please indicate the degree you plan to pursue after completing your time at NIH.

3. Coursework and Grades
Please enter all the courses you have completed, not just your science courses, Also enter any courses you are currently taking or in which you will enroll during your final semester. As you receive grades for these courses, add them here using the Modify Application tool.
Course Title Grade

4. 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.

5. References

Once you submit your completed application, an e-mail request for a letter of recommendation will automatically be sent to each of the following individuals:

Reference 1:

Name:


	First	MI	Last

Address:

Phone:

E-mail:

Format: user@server.com

Reference 2:

Name:


	First	MI	Last

Address:

Phone:

E-mail:

Format: user@server.com

Reference 3:

Name:


	First	MI	Last

Address:

Phone:

E-mail:

Format: user@server.com

6. Research Interests
6a. Areas of Scientific Interest:

6b. Medical Entity/Disease:

The NIH Academy and Postbaccalaureate IRTA program applications require separate cover letters. (See the instructions below for details on what to include in each letter.) Candidates who wish to be considered for both programs must provide both cover letters, as indicated in the fields below. To activate the second Cover Letter window, click on the check box provided.

7. Cover Letter:
Please write a cover letter outlining your research interests, career goals, and reasons for applying for training at the NIH.

Optional - Click here if you would also like to apply to the NIH Academy program.
[A separate cover is required if this box is checked.]

NIH Academy applicants: Please write a cover letter describing your research interests, career goals, and your interest in health disparities.

Postbaccalaureate IRTA Training Locations
Postbaccalaureate IRTA training occurs on several sites including the main campus in Bethesda, MD. To help our investigators, please indicate ALL locations where you would be willing to train.
Bethesda, MD (main NIH campus) Frederick, MD (some NCI labs) Baltimore, MD (most NIA labs and all NIDA labs) Research Triangle Park (Raleigh/Durham), NC (NIEHS only) Hamilton, MT (limited positions in NIAID) Phoenix, AZ (limited positions in NIDDK) Detroit, MI (limited positions in NICHD)

8. 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:
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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