Form 6 form

KirschsteinNRSA Individual Fellowship Application (To be completed by applicant – follow PHS 416-1 instructions)					NAME OF APPLICANT (Last, first, middle initial)      
SPONSOR and Co-Sponsor Information
15. NAME OF SPONSOR			16. NAME OF Co-SPONSOR (When applicable)
15a. NAME AND DEGREE(S)      			16a. NAME AND DEGREE(S)      
15b. ERA COMMONS USER NAME		     	16b. ERA COMMONS USER NAME			     
15c. DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT      			16c. DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT      
15d. MAJOR SUBDIVISION      			16d. MAJOR SUBDIVISION      
15e. Address:      			16e. Address:      
Telephone:	     		Telephone:	     
Fax:	     		Fax:	     
E-Mail:	     		E-Mail:	     
RESEARCH PROPOSAL
17. DESCRIPTION: See instructions. State the application’s broad, long-term objectives and specific aims, making reference to the health relatedness of the project (i.e., relevance to the mission of the agency). Describe concisely the research design and methods for achieving these goals. Describe the rationale and techniques you will use to pursue these goals. In addition, in two or three sentences, describe in plain, lay language the relevance of this research to public health. If the application is funded, this description, as is, will become public information. Therefore, do not include proprietary/confidential information. DO NOT EXCEED THE SPACE PROVIDED.
     

PHS 416-1 (Rev. 10/08) Page 2 Number pages consecutively at the bottom throughout Form Page 2
the application. Do not use suffixes such as 2a, 2b.