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GRADUATE PARTNERSHIP PROGRAM
OMB No. 0925-0299
Expiration Date 03/31/2014
Respondent Burden
REGISTER FOR AN INDIVIDUAL PARTNERSHIP
MYGPP | SIGN-OFF
Instructions: Before you begin, you may want to review some helpful hints on using this electronic form and our privacy statement.
Eligibility Criteria:
You must meet the following criteria to complete the NIH Graduate Partnerships Program (GPP) Registration Form as a PhD graduate
student performing part or all of your dissertation research within the NIH Intramural Research Program.
You are creating an Individual Partnership, in which you must have the following established prior to completing this online form, no
exceptions.
You enrolled in a PhD or equivalent program (PharmD, MD/PhD, DVM/PhD, etc�)
You have discussed the NIH Individual Partnership with your graduate program chairperson
You have been granted permission to pursue the Individual Partnership by the graduate program chairperson
You have identified and contacted tenured/tenure-track NIH investigators that have similar research interests and may be
interested in you performing dissertation research in their group within the NIH-IRP
You have received an official offer to perform dissertation research within the NIH Intramural Research Program by a
tenured/tenure-track NIH-IRP investigator
Your training period at NIH will be six-months or longer
Application Tips:
This form allows you to save a partially completed application. To take advantage of this feature:
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. You will have to return later to complete
your application.
When you first submit your partial application, you will receive an e-mail message containing instructions for accessing the online
tool that allows you to review, modify, and complete your application.
Only completed applications are available for review by NIH investigators and administrators; partial applications are not accessible by
NIH investigators. 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 select the "Save" button on the Preview
page.
1. Please read the "Graduate Partnership Program page" before beginning your online application.
2. Be sure that the e-mail addresses you provide is accurate. Incorrect e-mail addresses will delay the processing of your registration.
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 appear as you intend, 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
https://training-test.od.nih.gov/apps/publicForms/gpp/forms/indiShortApp.aspx
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Graduate Partnership Program
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special formatting, you will need to rely on the use of capital letters, white space, asterisks, and other standard keyboard
characters.
4. Proofread your registration thoroughly for accuracy and completeness; false or inaccurate information may be grounds for denying
your candidacy or removing you from the program.
Indicates a required field.
Indicates a help button.
Partnership
Partnership Type: Individual Partnership
Academic Information
PhD Degree Academic Information
This section is required.
College/University Name:
Start Date:
Anticipated Graduation Date:
Major Field of Study:
Mentor University Professor 1:
Mentor University Professor 2:
Do you have an MD or DDS or DVM or RN Degree?
Yes
No
MD-DDS-DVM-RN Institution
This section is required if you indicated above that you have or are enrolled in an MD or DDS or DVM or RN degree.
Degree Program:
Y
College or University Name:
Major Field of Study:
Start Date:
Anticipated Graduation Date:
NIH Training Information
NIH Insitiute-Center:
National Cancer Institute
Mentor NIH Investigator 1:
Mentor NIH Investigator 2:
Start Date at NIH as a Graduate Student:
Anticipated Duration of Training:
Jan
2012
0-3-months
NIH Administrative Officer:
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Graduate Partnership Program
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Additional Information
Please enter any additional information. (Up to 1500 characters)
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.
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Respondent Burden
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RESPONDENT BURDEN
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Statement for Applicants/Registrants
Public reporting burden for this collection of information is estimated to average 60-minutes per submission, including the time for
reviewing instructions, frequently asked questions, and entering data in the form fields. 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.
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. 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.
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Privacy Statement
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PRIVACY ACT NOTIFICATION STATEMENT
MESSAGE
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The primary use of information collected via the Office of Intramural Training and Education (OITE) online forms is to evaluate an
applicant's qualifications for research training at the National Institutes of Health (NIH). Information may be used during admission
consideration; in preparing appointment paperwork; and to provide data for training program evaluation. Information will be disclosed
to investigators, members of advisory committees, OITE staff, and contractors working on our behalf. Additional disclosures may be
made to law enforcement agencies concerning violations of law or regulation. Application for this program is voluntary; however, in
order for the OITE to process an application, the applicant must complete the required fields.
The legal authority granted to NIH to train future biomedical scientists comes from several sources. Title 42 of the U.S. Code, Sections
241 and 282(b)(13) authorize the Director, NIH, to conduct and support research training for which fellowship support is not provided
under Part 487 of the Public Health Service (PHS) Act (i.e., National Research Service Awards), and that is not residency training of
physicians or other health professionals. Sections 405(b)(1)(C) of the PHS Act and 42 U.S.C. Sections 284(b)(1)(C) and 285-287 grant this
same authority to the Director of each of the Institutes/Centers at NIH.
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| File Type | application/pdf |
| File Title | Graduate Partnership Program |
| Author | Patty Wagner |
| File Modified | 2013-05-24 |
| File Created | 2013-02-08 |