Form 1 NIH Amgen Supplemental Questions

NIH-AMGEN SCHOLARS PROGRAM
OMB No. 0925-0299
Expiration Date: August 31, 2016
Respondent Burden: Public reporting burden for this collection of information is estimated to average 5minutes 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.

The NIH-Amgen Scholars program is utilizing a two-step application process for Summer 2015
admission. Applicants for the NIH-Amgen Scholars program must complete the NIH Summer Internship
Program (SIP) application as well as the supplemental questions provided below. To ensure a match
between the two applications, please be certain your name and e-mail address provided below match
the data in your SIP application.
If you have any questions or concerns, please e-mail [email protected] at your earliest
convenience.

CONTACT INFORMATION
First Name (Given Name):*

Last Name (Family Name):*

Permanent E-mail Address:*
(Check accuracy; not your university e-mail address)

ADDITIONAL ACADEMIC INFORMATION
High School City:*

High School State:*

Year of Expected Graduation from your Undergraduate College/University:*
(Example: 2015)

What is your ultimate Degree Objective? *

HOW DID YOU HEAR ABOUT THE AMGEN SCHOLARS PROGRAM?
Amgen National Web Site:*
Yes

No

Academic Advisor:*
Yes

No

E-mail:*
Yes

No

Faculty/Staff from Home University:*
Yes

No

Internet Search:*
Yes

No

Poster:*
Yes

No

Conference:*
Yes

No

Faculty/Staff from Other University:*
Yes

No

University Web Site:*
Yes

No

Other:*
Yes

No

RESEARCH EXPERIENCE
DELETE-02
Are you applying to other Amgen Sites?*
Yes

No

Have you participated as an Amgen Scholar in the past?*
Yes

No

Have you participated in the NIH Summer Internship Program in the past, either as an
intern or as a volunteer?*
Yes

No

Have you participated in research as an undergraduate (academic year or summer)?*
Yes

No

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