Form 14 NAVW-Recommendation Letters

NATIVE AMERICAN VISIT WEEK ‐RECOMMENDATION LETTER
OMB Clearance Number: 0925-0299
Expiration Date: 30-Jun-2019

STUDENT INFORMATION
Student First Name (Given Name):

Student Last Name (Family Name):

Student E‑mail Address:

REFERENCE INFORMATION
Reference Title:

Reference First Name (Given Name):

Reference Last Name (Family Name):

Reference E‑mail Address:

LETTER OF RECOMMENDATION
How long have you known the student?

In what capacity have you known the student?

Letter of Recommendation

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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.

Public reporting burden for this collection of information is estimated to average 10 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. 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 0MB 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.