Form 8 Post-Doctoral Fellowship Program

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NIH POSTDOCTORAL FELLOWSHIP PROGRAM
POSTDOCTORAL APPLICATION
OMB No. 0925-0299
Expiration Date 9/30/2012
Respondent Burden
Please note: There is a limit on the total number of postdoctoral fellowship applications you may submit through this online system.
You may submit up to ten (10) applications per 12-month period. Each application you submit counts toward your total; there is no
way to "retract" an application once it is submitted. For these reasons, the NIH Office of Intramural Training & Education (OITE) urges
you to be discriminating when choosing to apply for a fellowship.
Instructions: Before you fill out the form below, you may find it helpful to review some hints on using this electronic form. You may
also wish to review a statement regarding privacy After filling out the form, press the [Preview Application] button at the bottom of
the page. Then, once you have reviewed your application for accuracy and are satisfied that the contents are correct, press the [Save
Application] button to save your data and complete the application process. A notification message will be sent to Dr. Lilly, at
[email protected], and you will receive an application confirmation message by e-mail.
Indicates a required field!

Postdoctoral Application
PD-4876: Drosophila Cell Cycle Regulation

1. Personal Information
Name:

Mr.
First

Month/Day of Birth:

/

MI

Last

(mm/dd)
Format: [email protected]

E-mail Address:
To obtain a free e-mail address, click here

Permanent Address:

City:
State:
Zip/Postal Code:

Candidates from the international community should enter NA in this field

Country/Region:

United States

Permanent Home Phone:
Citizenship Status:

US Citizen
If Permanent Resident:

Country of Citizenship

TOEFL Score:

Alien Registration No.

Required for Permanent Residents or Foreign Nationals

Current Visa Status:
Years of Postdoctoral
Research Experience:
Previous Research
Experience at NIH:
Type of NIH Research
Experience (if any):

2. Curriculum Vitae

3. Publications

4. Cover Letter

Summer

Postbaccalaureate

Graduate School

Postdoctoral

Medical/Dental Predoctoral

Medical/Dental Residency

5. If not selected for this position, would you like to be considered for other Postdoctoral opportunities?

6. Reference
Reference 1 (Name, Address, Phone, Email):
Name:

Mr.
First

MI

Last

Address:
Phone:
E-mail:

Format: [email protected]

Reference 2 (Name, Address, Phone, Email):
Name:

Mr.
First

MI

Last

Address:
Phone:
E-mail:

Format: [email protected]

Reference 3 (Name, Address, Phone, Email):
Name:

Mr.
First

MI

Last

Address:
Phone:
E-mail:

Format: [email protected]

7. Areas of NIH Research Interest
1.

Other:

2.

Other:

3.

Other:

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.
Preview Application

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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.