Form 1 OMBFT Alumni Database Registration Collection

CREATE AN NIH ALUMNI DATABASE ENTRY
OMB Number: 0925-0740 (Expiration Date: May 2019)
Public reporting burden for this collection of information is estimated to average 10-minutes per submission. 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 0925-0740. Do not return the completed form to this address..

Thank you for taking the time to create an entry for yourself in the NIH Alumni Database. This is a new
venture for the NIH Office of Intramural Training & Education (OITE) and we have big plans.
You may be wondering why you should take the time to complete the brief form below today and
keep your entry up to date in the future. Here are several reasons:
First, what's in it for YOU? Networking! You will be helping to create a searchable database of
potential colleagues that you can mine to meet your own needs and those of your students and
friends. But, in addition
The OITE invites former NIH trainees to speak at events like the Career Symposium and the National
Graduate Student Research Festival. The success of those ventures depends on our keeping in
contact with a diverse group of NIH alumni that could include you.
Applicants to NIH training programs often want to know where program participants go next. Where
do NIH postbacs go to graduate or professional school? Where do NIH postdocs find jobs? You can
help us provide those data.
If you wish, you can become part of a worldwide network of NIH alumni who are willing to answer
current trainees' questions about schools and jobs.
Database Rules:
Information that you enter into the database will be made public e.g., in publications describing NIH
programs, only in the aggregate; no personally identifiable information will be published outside of
this system.
Your personally identifiable information (see below) will be included in the searchable database only
if you authorize the OITE to include it. You can change your mind at any time.
Only Alumni Database account-holders, current NIH trainees, and NIH staff will be able to search the
Database.
You can update your educational and/or employment history and preferences at any time.
Honorary Title:
First Name*:
Middle Name:
Last Name*:
Street:

City:
State:
Zip:
Country:

Phone Number:
Permanent E-mail*:

e.g., gmail, hotmail

Confirm Permanent Email*:
Password*:
Verify Password*:
NIH History:
Please tell us about any time that you have spent at the NIH. List your most recent
experience first and list all experiences in reverse chronological order.
Institute/Center (IC)*:
NIH Training Program*:
When were you at the
NIH for this program*:

Hold the control key and select multiple years to enter a date
range.
prior to 1970
1970
1971
1972
1973
1974

NIH PI:

Add NIH Information

Member of:

During my time at the NIH, I was a member of (check all that
apply)
FelCom (The NIH Fellows Committee)
The GSC (Graduate Student Council)
The Postbac Committee

Current Status*:
Education:
Please tell us about your education. List your highest or most recent degree first. Please also
complete this section if you have been accepted to and plan to enter a degree program.
School*:
City*:
State*:
Country:
Degree(s)*:

BA/BS

MS

PhD

MD

MD/PhD

DO

PharmD

DDS

DDS/PhD

DMD

DVM

MBA

JD

Other

Date of Degree Receipt:
Major/Option/Program:

If applicable

Current Institution:

I am currently enrolled at this institution

Delete

Add Education Information
Employment:
If you have accepted a postdoc or job offer, or are currently employed, please complete this
section. If you have held multiple positions, please list them in reverse chronological order.

Organization*:
Department:
City*:
State*:
Country:
Job Title/Function*:
Annual Salary:
Description of
Bonus/Benefits:
Additional Comments:

Employment Sector:

Academic - Research University
Academic - University, primarily teaching
Academic - Community College
Communications
Consulting
Government - Federal
Government - State
Government - Other
Healthcare
Industry
Non-profit - Funder
Non-profit - Public Health
Professional Organization
Science Policy
Writing/editing

Current Institution:
Dates of Employment*:

I am currently employed by this institution
Hold the control key and select multiple years to enter a date
range.

prior to 1970
1970
1971
1972
1973
1974

Delete

Add Employment Information
Networking Contact*:

Are you willing to serve as a networking contact for NIH
trainees? We anticipate that they might seek your advice on
career planning, the graduate/professional school application
process, the job search process, or your particular position.
Note: By clicking yes, you are authorizing OITE to include you
in the searchable database. By clicking no, you will not be
included in any search results provided to the public.
Yes

Career Counselor
Contact*:

Would you be willing to be a contact for career counselors in
the Office of Intramural Training & Education at the NIH or
OITE staff organizing training events?
Yes

Contact Method:

No

No

What is your preferred method of contact
E-mail

Event Speaker*:

Phone

I would be interested in speaking at a future career
development event.
Yes

No

Submit Registration

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