Program Director/Principal Investigator (Last, First, Middle): |
|
||||||||||||||
Trainee Diversity Report |
|||||||||||||||
This report format should NOT be used for data collection from trainees. |
|||||||||||||||
Training Grant Title: |
|
||||||||||||||
Total Number of Appointed: |
|
||||||||||||||
Grant Number: |
|
||||||||||||||
|
|||||||||||||||
PART A. TOTAL TRAINEE APPOINTMENTS REPORT: Number of Trainees Appointed by Ethnicity and Race |
|||||||||||||||
Ethnic Category |
Sex/Gender |
||||||||||||||
Females |
Males |
Unknown or Not Reported |
Total |
||||||||||||
Hispanic or Latino |
|
|
|
|
** |
||||||||||
Not Hispanic or Latino |
|
|
|
|
|
||||||||||
Unknown (individuals not reporting ethnicity) |
|
|
|
|
|
||||||||||
Ethnic Category: Total of All Trainees* |
|
|
|
|
* |
||||||||||
Racial Categories |
|
||||||||||||||
American Indian/Alaska Native |
|
|
|
|
|
||||||||||
Asian |
|
|
|
|
|
||||||||||
Native Hawaiian or Other Pacific Islander |
|
|
|
|
|
||||||||||
Black or African American |
|
|
|
|
|
||||||||||
White |
|
|
|
|
|
||||||||||
More Than One Race |
|
|
|
|
|
||||||||||
Unknown or Not Reported |
|
|
|
|
|
||||||||||
Racial Categories: Total of All Trainees* |
|
|
|
|
* |
||||||||||
|
|||||||||||||||
PART B. HISPANIC TRAINEE APPOINTMENTS REPORT: Number of Hispanics or Latinos Appointed |
|||||||||||||||
Racial Categories |
Females |
Males |
Unknown or Not Reported |
Total |
|||||||||||
American Indian or Alaska Native |
|
|
|
|
|
||||||||||
Asian |
|
|
|
|
|
||||||||||
Native Hawaiian or Other Pacific Islander |
|
|
|
|
|
||||||||||
Black or African American |
|
|
|
|
|
||||||||||
White |
|
|
|
|
|
||||||||||
More Than One Race |
|
|
|
|
|
||||||||||
Unknown or Not Reported |
|
|
|
|
|
||||||||||
Racial Categories: Total of Hispanics or Latinos** |
|
|
|
|
** |
||||||||||
|
|||||||||||||||
PART C. TRAINEES WITH DISABILITIES OR FROM DISADVANTAGED BACKGROUNDS |
|||||||||||||||
Number of Trainees with Disabilities: |
|
|
|||||||||||||
Number of Trainees from Disadvantaged Backgrounds: |
|
|
|||||||||||||
(*) (**) These totals must agree. |
PHS 2590 (Rev. 09/07) Page Trainee Diversity Report Format Page
File Type | application/msword |
File Title | PHS 2590 (Rev. 9/07), Trainee Diversity Report |
Subject | DHHS, Public Health Service Grant Application |
Author | Office of Extramural Programs |
Last Modified By | curriem |
File Modified | 2007-09-14 |
File Created | 2007-09-14 |