Form 2 SIP- Amgen Scholars at NIH - Supplement Application

NIH-AMGEN SCHOLARS PROGRAM
OMB No. 0925-0299
Expiration Date: August 31, 2016
Respondent Burden
The NIH-Amgen Scholars program is utilizing a two-step application process for 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: 2016)

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
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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