Form 12 GDSSP Alumni Tracking

GRADUATE DATA SCIENCE SUMMER PROGRAM (GDSSP) ‐ ALUMNI TRACKING
OMB Clearance Number: 0925-0299
Expiration Date: 30-Jun-2019

GENERAL INFORMATION
First Name (Forename; Given Name):

Last Name (Surname; Family Name):

Personal Email Address (check accuracy):

Permanent Phone Number (check accuracy):

GDSSP PARTICIPATION INFORMATION
GDSSP Participation Year:

NIH Institute‑Center:

NIH Campus Location:

NIH Investigator:

What was the most helpful thing you learned from your internship at NIH?

MASTER UNIVERSITY INFORMATION
MS Degree ‑ University Name:

MS Degree ‑ School / College /Program Name:

MS Degree ‑ Start State

MS Degree ‑ Graduation Date:

MS Degree ‑ Thesis or Capstone Project Title:

GRADUATE UNIVERSITY

Graduate University

Graduate School / College Name:

Graduate University Start Date:

Graduate University Graduation Date:

Graduate Degree Awarded:

Graduate Dissertation Title:

CAREER DEVELOPMENT
What is your current professional status?

Which programs have you applied for admission?

Which programs have you been awarded?

What is your long‑term career goal (5‑years or 10‑years beyond graduation):

Collection of this information is authorized by The Public Health Service Act, Section 410 (42 USC 285). Rights
of participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties
for not participating or withdrawing from the study at any time. The information collected in this study will
be kept private to the extent provided by law. Names and other identifiers will not appear in any report of the
study. Information provided will be combined for all participants and reported as summaries.