Form 2 BESIP

Go

home

for prospective applicants

BIOMEDICAL ENGINEERING SUMMER INTERNSHIP PROGRAM
OMB No. 0925-0299
Expiration Date 03/31/2014
Respondent Burden
PROGRAM APPLICATION
Instructions: Before you begin, you may want to review some helpful hints on using this electronic form and our privacy statement.
If you wish to MODIFY a submitted application, please go to the BESIP home page and click on the link for Modify Existing Application.
A list of projects and mentors for previous BESIP Programs can be found at the BESIP web site. Mentors and projects for Summer 2013
will be available by February for the Summer 2013 program.

Eligibility Criteria:
1. Eligibility for the BESIP program can be found at the BESIP web site. The BESIP program is for undergraduate bioengineering
students only who have completed their junior level requirements by the time the 2013 summer program starts and will be returning
to their undergraduate school for at least one additional semester after the 2013 BESIP program. No majors other than
bioengineering and biomedical engineering will be accepted into the program.
2. Candidates must be U.S. citizens or permanent residents, and be attending a college or university in the United States.
Application Tips:
This form has recently been revised to allow you to save a partially completed application. To take advantage of this feature, please
proceed as follows:
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, and return later to complete your
application.
When you first submit your partial application, you will automatically receive a confirmation e-mail containing login information
and instructions for accessing the online tool that allows you to review, modify, and complete your application.
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 click the "Save" button on the Preview page.
IMPORTANT NOTE: All fields on your application must be completed by February 9, 2013 (midnight, Eastern Standard Time).
Applications that are incomplete after the 2/11 deadline will not receive further consideration.
1. Please read "Application Information" before beginning to complete your online application.
2. Be sure that the e-mail addresses you provide for your references are accurate. Incorrect e-mail addresses will delay the
processing of your application and could result in your application's not receiving full consideration.
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 appears as you intend it to,
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 characters.
4. Proofread your application thoroughly for accuracy and completeness; false or inaccurate information may be grounds for denying
your candidacy or removing you from the program.
5. Complete your application as soon as possible and encourage your references to submit their letters promptly using the electronic
system.
6. The deadline for receipt of completed applications is February 9, 2013 (midnight, Eastern Standard Time). Applications that are
incomplete after the 2/9 deadline will not receive further consideration. Be sure that your letters of recommendation are
submitted online by February 13, 2013.
7. Sections 7, 8, and 9 of this application are not necessary when applying to the BESIP program but may be optionally filled out if
you wish this application to be also considered later for the regular Summer Internship Program (SIP) in the event that you are not
selected for BESIP.
Indicates a required field.

Indicates a help button.

1. Personal Information
You must enter this information if you wish to save your application.
Name:

Mr.
First

Month/Day of Birth:

/

MI

Last

(mm/dd)

Permanent Home Phone:

Format: (999) 999-9999
Format: [email protected]

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

Personal Information - Continued
Permanent Address:

City:
State:

(DC for Washington D.C.)

Zip Code:
US Citizen
If Permanent Resident:
Citizenship Status:
Country of Citizenship

Alien Registration No.

Previous Research Experience at NIH (Programs
completed):

None

Relative at NIH/FDA:

Yes

No

If yes, relative employed by:

NIH summer training occurs on several sites including the main campus in Bethesda, MD. To help our investigators, please
indicate ALL locations where you would be willing to train this summer.
Baltimore, MD (most NIA labs and all NIDA labs)

Baltimore, MD (most NIA labs and all NIDA labs)
Bethesda, MD (main NIH campus)
Detroit, MI (limited positions in NICHD)
Frederick, MD (some NCI labs)
Hamilton, MT (limited positions in NIAID)
Phoenix, AZ (limited positions in NIDDK)
Research Triangle Park (Raleigh/Durham), NC (NIEHS only)

2. Academic Information
School:
Preferred Mailing Address:

City:
State:

(DC for Washington D.C.)

Zip Code:
Preferred Phone Number:

Format: (999) 999-9999

Current Education Level:
Year at Current Level:
Anticipated Graduation Date:
Current Cumulative GPA:
School Grading Scale:
Note: If you select 'Other', please explain in Section 3, Coursework and Grades. Be sure
to describe your school's grading scale and your current cumulative average relative to
that scale.
Total Credit Hours
(by the end of this semester):
Academic Major:

or

3. Coursework and Grades Include courses that you are currently enrolled in.

4. CV/Resume
Copy and paste a plain text version of your curriculum vitae into this space. Minor reformatting may be necessary. Include education,
relevant research experience, scientific publications, honors and awards, etc.

5. References
Once you submit your completed application, an e-mail request for a letter of recommendation will automatically be sent to each of
the following individuals:
Reference 1:
Name:

Mr.
First

MI

Last

Address:
Phone:
E-mail:

Format: [email protected]

Reference 2:
Name:

Mr.
First

MI

Last

Address:

Phone:
E-mail:

Format: [email protected]

6. Cover Letter: Describe your research interests, career goals, and reasons for applying for training at the NIH; be certain that your
cover letter is specific for this particular program.

Summer Internship Program (SIP)
Section 7, 8 and 9 apply to the Summer Internship Program (SIP). In the event that you are not selected for BESIP, your application will
be forwarded to the SIP program automatically. At that time, you must direct any inquires about summer positions to the SIP Program
Coordinator in the Office of Intramural Training & Education and not the BESIP Program Director.
To help you define your research interests and make the best choice -- for you -- of a summer training opportunity in SIP, you can
select RESEARCH INTERESTS as follows:
Areas of Scientific Interest: Up to three (3) choices from the drop-down list
Medical Entity/Disease: Up to three (3) choices from the drop-down list
There are no wrong choices: you may select only 1 category or as many as 6. Choose what best reflects your interests and abilities.
Investigators at NIH will then search the system according to their needs and look for the best match of your talents and their
research projects for the summer.

7. Areas of Scientific Interest:
1.
2.
3.

8. Medical Entity/Disease:
1.
2.
3.

9. I would like to be considered for the following Institute/Center:

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.
Save Partial Application & Quit

NIH Home
Privacy Notice

DHHS

USA.gov

Disclaimers

About Us
FOIA

Site Search

Contact Us

Preview Completed Application

Accessibility

Go

home

BIOMEDICAL ENGINEERING SUMMER INTERNSHIP PROGRAM
LETTER OF RECOMMENDATION FOR MR. TEST-PATRICIA TEST-WAGNER
OMB No. 0925-0299
Expiration Date 3/31/2014
Respondent Burden
Instructions:
Copy and paste your letter of reference into the boxed area below. (Note: We recommend that you compose your letter off-line
and paste it into the space below. If you attempt to compose your letter while logged on to this site, you may experience a
connection timeout or some other technical problem beyond our control, which may result in your text being irretrievably lost.)
Click on the button below to submit your letter.

Reference Letter
Please update the fields below so that they correctly reflect your name, phone number and address.
Name:

Mr.
Title

REF1-Firstname
First Name

Address:

REF1-Address

Phone:

(111) 111-1111

REF1-Lastname
MI

Last Name

Reference Letter
Please include your name, academic rank, department and institution in your signature block.

Submit

NIH Home
Privacy Notice

DHHS

USA.gov

Disclaimers

About Us
FOIA

Site Search

Contact Us

Accessibility

Respondent Burden

3/6/13 3:02 PM

Go

home

RESPONDENT BURDEN
Back to Previous Page
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.

Back to Previous Page

NIH Home
Privacy Notice

DHHS

USA.gov

Disclaimers

About Us
FOIA

Site Search

Accessibility

Contact Us

http://www2.training.nih.gov/apps/messages/programs/formsV2/resburden.aspx

Page 1 of 1

Privacy Statement

3/6/13 3:03 PM

Go

home

PRIVACY ACT NOTIFICATION STATEMENT
MESSAGE
Back to Previous Page
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.
Back to Previous Page

NIH Home
Privacy Notice

DHHS

USA.gov

Disclaimers

About Us
FOIA

Site Search

Accessibility

Contact Us

http://www2.training.nih.gov/apps/messages/programs/formsV2/privacy.aspx

Page 1 of 1