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for prospective applicants

NIH ACADEMY
PROGRAM APPLICATION
FOR RECENT COLLEGE GRADUATES WHO HAVE AN INTEREST IN HEALTH DISPARITIES
OMB No. 0925-0299
Expiration Date 9/30/2012
Respondent Burden
If you have already applied to the Postbaccalaureate IRTA program and would also like to apply to the NIH Academy, do not use the form
below; instead, click here to apply using your Postbaccalaureate IRTA 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: All fields on your application must be completed by January 7, 2011 (9:00 AM, Eastern Standard Time). Applications
that are incomplete after the 1/7 deadline will not receive further consideration.

Tips for Applying Successfully:
1. If you are applying to the Postbac IRTA program, review the Postbac IRTA program description and "Frequently Asked Questions"
before beginning your online application. If you are applying to the NIH Academy, review the NIH Academy program description 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 our online
system.
6. NOTE: There is no deadline for applying to the Postbac IRTA program; applications are accepted on a rolling basis. If you are applying
to the NIH Academy, you must complete all fields on your application by January 7, 2011 (midnight, Eastern Standard Time).
Applications that are incomplete after the 1/7 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 January 28, 2011.

https://training-test.od.nih.gov/apps/publicForms/afpi/formsV2/afpiApp.aspx?appType=A

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NIH Office of Intramural Training & Education - Online Application

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Eligibility Criteria:
1. Candidates must be U.S. citizens or permanent residents and intend to apply to graduate or medical school within the next year.
2. 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.
3. Candidates for the NIH Academy Program must have graduated with their first Bachelors 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
You must enter this information if you wish to save your application.
Name:

Mr.
First

Month/Day of Birth:
E-mail Address:

MI

/

Last

(mm/dd)

To obtain a free e-mail address, click here

Preferred Phone Number:

    Format: [email protected]

    Format: (999) 999-9999

Personal Information - Continued
Permanent Address:

City:

State:

 (DC for Washington D.C.)

Zip Code:

Permanent Home Phone:
Citizenship Status:

    Format: (999) 999-9999

US Citizen
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:
Education Plans:

 / 

  (mm/yyyy)
  or 

  Note: Please indicate the degree you plan to pursue after completing your time at NIH.

https://training-test.od.nih.gov/apps/publicForms/afpi/formsV2/afpiApp.aspx?appType=A

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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:

Mr.
First

MI

Last

Address:

Phone:

E-mail:

Format: [email protected]

Reference 2:
Name:

Mr.
First

MI

Last

Address:

Phone:

E-mail:

Format: [email protected]

https://training-test.od.nih.gov/apps/publicForms/afpi/formsV2/afpiApp.aspx?appType=A

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Reference 3:
Name:

Mr.
First

MI

Last

Address:

Phone:

E-mail:

Format: [email protected]

6. Research Interests
6a. Areas of Scientific Interest:
1.
2.
3.

6b. Medical Entity/Disease:
1.
2.
3.

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 describing your research interests, career goals, and your interest in health disparities.

Optional - Click here if you would also like to apply to the Postbaccalaureate IRTA program.
     [A separate cover is required if this box is checked.]
Postbaccalaureate IRTA applicants: Please write a cover letter outlining your research interests, career goals, and reasons
for applying for training at the NIH.

https://training-test.od.nih.gov/apps/publicForms/afpi/formsV2/afpiApp.aspx?appType=A

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NIH Office of Intramural Training & Education - Online Application

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Click the check box
box above
above if
if you
you would also like to apply for the Postbaccalaureate IRTA program at this time.

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
MD (some
(some NCI
NCI labs)
labs)
Baltimore, MD (most NIA labs and all NIDA labs)
labs)
Research Triangle Park (Raleigh/Durham), NC (NIEHS only)
only)
Hamilton, MT (limited positions in NIAID)
Phoenix, AZ (limited positions in NIDDK)
NIDDK)
Detroit, MI (limited
(limited positions
positions in
in NICHD)
NICHD)

 How did you hear about this program? (Please select all that apply.)
Ad in a scientific journal (Nature, Science); please specify:
Ad in a student journal; please specify:
Ad in a meeting program
Exhibit at a meeting; please specify:
Career development/opportunities workshop
Flier
Poster
From a mentor or advisor
From an alumnus/alumna of the program
NIH representative visited school
Web search
Other; please specify:
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.

Save Partial Application & Quit

NIH Home
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DHHS

USA.gov

Disclaimers

About Us
FOIA

Site Search

Preview Completed Application

Accessibility

Contact Us

https://training-test.od.nih.gov/apps/publicForms/afpi/formsV2/afpiApp.aspx?appType=A

1/20/2011

Burden Disclosure Statement for Applicants –
Public reporting burden for this collection of information is estimated to average 45-minutes for
the application and 45-minutes for the supplemental material per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda,
MD 20892-7974, ATTN: PRA (0925-0299). Do not return the completed form to this address.

Burden Disclosure Statement for References –
Public reporting burden for this collection of information is estimated to average 15-minutes per
response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705
Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0299). Do not
return the completed form to this address.