Form 34 MyOITE-Alumni

CREATE AN NIH ALUMNI DATABASE ENTRY

OMB Number: 0925‑0299
Expiration Date: 30‑June‑2019
Thank you for taking the time to create an entry for yourself in the NIH Alumni Database. This is a new
venture for the NIH Office of Intramural Training & Education (OITE) and we have big plans.
You may be wondering why you should take the time to complete the brief form below today and keep your
entry up to date in the future. Here are several reasons:
~ First, what's in it for YOU? Networking! You will be helping to create a searchable database of potential
colleagues that you can mine to meet your own needs and those of your students and friends. But, in
addition
~ The OITE invites former NIH trainees to speak at events like the Career Symposium and the National
Graduate Student Research Festival. The success of those ventures depends on our keeping in contact with a
diverse group of NIH alumni that could include you.
~ Applicants to NIH training programs often want to know where program participants go next. Where do
NIH postbacs go to graduate or professional school? Where do NIH postdocs find jobs? You can help us
provide those data.
~ If you wish, you can become part of a worldwide network of NIH alumni who are willing to answer current
trainees' questions about schools and jobs.
Database Rules:
~ Information that you enter into the database will be made public e.g., in publications describing NIH
programs, only in the aggregate; no personally identifiable information will be published outside of this
system.
~ Your personally identifiable information (see below) will be included in the searchable database only if you
authorize the OITE to include it. You can change your mind at any time.
~ Only Alumni Database account‑holders, current NIH trainees, and NIH staff will be able to search the
Database.
~ You can update your educational and/or employment history and preferences at any time.
CONTACT INFORMATION
Honorary Title:

First Name (Given Name):

Last Name (Family Name):

State:

Country:

Permanent Email (non‑NIH):

Permanent Email (non‑NIH) ‑ Confirm:

What is your current status?

EDUCATION HISTORY

Please tell us about your education. List your highest or most recent degree first. Please also complete this
section if you have been accepted to and plan to enter a degree program.
(duplicate this data block for each degree selected, even those programs just beginning)
Degree(s) Awarded:

(select all that apply)

search here

BA / BS
MS
MPH
PhD / DPhil
0 of 16 selected  [ show selected ]   [ show all ]
If other, indicate which degree?

School Name:

Academic Major:

School City:

School State:

School Country:

Education Start Date:

(omit day)

May

09

2019

Education Stop Date:

(omit day)

May

09

2019

NIH TRAINING INFORMATION

Please tell us about any time you have spent at the NIH. List your most recent experiences first and lists all
experiences in reverse chronological order.
(duplicate this data block for each training position selected, completed and beginning)
Tell us about your NIH training experiences, what was the last position that you held at NIH?

Institute‑Center:

Investigator's Name:

NIH Start Date:

(omit day)

May

09

2019

09

2019

NIH Stop Date:

(omit day)

May

Member of Trainee Committee:

(select all that apply)
FelCom (The NIH Fellows Committee)
The GSC (Graduate Student Council)
The Postbac Committee

NEXT STEP
What is your next step?

EMPLOYMENT

If you have accepted a postdoc or job offer, or are currently employed, please complete this section. If you
have held multiple positions, please list them in reverse chronological order.
(fields in original alumni database)
Employment ‑ Organization:

Employment ‑ Department:

Employment ‑ City:

Employment ‑ State:

Employment ‑ Country:

Employment Start Date:

(omit day)

May

09

2019

Employment Stop Date (if applicable):

(omit day)

May

09

2019

What type of employment sector are you in?

What type of position are you in?

What are you doing in your position?

What type of research are you conducting?

(conditional display)
What are you specifically doing in your position?

(conditional display)

NETWORKING OPPORTUNITIES
Networking Contact:

Are you willing to serve as a networking contact for NIH trainees? We anticipate that they might seek your
advice on career planning, the graduate/professional school application process, the job search process, or
your particular position.
Note: By clicking yes, you are authorizing OITE to include you in the searchable database. By clicking no, you
will not be included in any search results provided to the public.
Yes

No

Career Counselor Contact:

Would you be willing to be a contact for career counselors in the Office of Intramural Training & Education at
the NIH or OITE staff organizing training events?
Yes

No

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 15 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 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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