Form 16 Recommendation Letters

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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

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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

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POSTBACCALAUREATE IRTA 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

REF2-Firstname
First Name

Address:

REF2-Address

Phone:

(222) 222-2222

REF2-Lastname
MI

Last Name

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

Submit

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SUMMER INTERNSHIP PROGRAM
LETTER OF RECOMMENDATION FOR MR. TEST-PATRICIA TEST-WAGNER
OMB No. 0925-0299

NOTE: The CCSEP uses the same
application form as the
Summer Internship Program.

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

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TECHNICAL IRTA 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

REF2-Firstname
First Name

Address:

REF2-Address

Phone:

(222) 222-2222

REF2-Lastname
MI

Last Name

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

Submit

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Graduate Partnership Program - Reference Letter Submission

2/12/13 3:26 PM

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GRADUATE PARTNERSHIP PROGRAM
LETTER OF RECOMMENDATION FOR {VARAPPLICANTNAME}
OMB No. 0925-0299
Expiration Date 3/31/2014
Respondent Burden
Instructions:
Please complete the form and click on the button below to submit your evaluation and letter of reference.
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.
Indicates a required field.
Evaluation Form
Length:

Capacity:

How long have you known the applicant?

In what capacity have you known the applicant?

The evaluation form asks for your assessment on several aspects using the following rating system.
5 = Exceptional - Top 1%
4 = Excellent - Top 10%
3 = Above Average - Top 25%
2 = Average - Top 50%
1 = Below Average - Bottom 50%
Note:
Overall Impression:
5

4

3

2

1

Intelligence:
5

4

Writing Ability:
3

2

1

Analytical Ability:
5

4

3

4

3

4

3

2

1

Interpersonal Skills:
2

1

Research Ability:
5

5

Initiative:

5

4

3

2

1

5

4

4

3

2

1

3

2

1

Honesty:
1

Motivation:
2

5

5

4

Knowledge of Field:
3

http://training-test.od.nih.gov/apps/refForms/gpp/forms/submitLetter.aspx

2

1

5

4

3

2

1
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Graduate Partnership Program - Reference Letter Submission

Verbal Ability:
5

4

3

2/12/13 3:26 PM

Confidence:
2

1

5

4

Maturity:
3

2

1

5

4

3

2

1

Recommendation Letter
Please copy and paste your letter of reference into the boxed area below. Please include your name, academic rank, department
and institution in your signature block.

Submit

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http://training-test.od.nih.gov/apps/refForms/gpp/forms/submitLetter.aspx

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RESEARCH CONFERENCE
LETTER OF RECOMMENDATION FOR 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.
Review Criteria for Applications

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.

Anticipated Ph.D. Completion Date:

Submit

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UNDERGRADUATE SCHOLARSHIP PROGRAM
LETTER OF RECOMMENDATION FOR MR. FIRSTNAME LASTNAME
OMB No. 0925-0299
Expiration Date 3/31/2014
Respondent Burden
Instructions:
Please complete the form and click on the button below to submit your evaluation and letter of reference.
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.
Indicates a required field.
Evaluation Form
How long have you known the applicant?

Length:

In what capacity have you known the applicant?

Capacity:

The evaluation form asks for your assessment on several aspects using the following rating system.
5 = Exceptional - Top 1%
4 = Excellent - Top 10%
3 = Above Average - Top 25%
2 = Average - Top 50%
1 = Below Average - Bottom 50%
Note: Mr. Firstname Lastname has waived access to view your letter of recommendation.
Overall Impression:
5

4

3

2

1

Intelligence:
5

4

Writing Ability:
3

2

1

2

1

Analytical Ability:
5

4

3

4

3

4

3

Service Obligation:

3

2

1

5

4

3

2

2

1

5

4

1

5

4

4

3

2

1

5

4

3

2

1

Knowledge of Field:
3

2

1

Confidence:
2

5

Honesty:
1

Motivation:

Verbal Ability:
5

4

Interpersonal Skills:

Research Ability:
5

5

Initiative:

5

4

3

2

1

3

2

1

Maturity:
3

2

1

5

4

Service Obligation:
Indicate the likelihood of the applicant completing the service obligation asscoiated with the UGSP scholarship.
5

4

3

2

1

Recommendation Letter
Please copy and paste your letter of reference into the boxed area below. Please include your name, academic rank, department
and institution in your signature block.

Submit

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Respondent Burden

3/6/13 3:02 PM

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

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Privacy Statement

3/6/13 3:03 PM

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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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