Attachment 3 Application Example

Attachment 3: Application Example

OMB No. 0925-XXXX

Expiration Date: xx/xx/20xx

Collection of this information is authorized by The Public Health Service Act, Section 411 (42 USC 285a). 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 application system at any time. Refusal to participate will not affect your benefits in any way. The information collected in this system will be kept private to the extent provided by law. Names and other identifiers will not appear in any report. Resumes will be maintained individually. You are choosing to submit your application on this website and will be contacted by email, if eligible.

Public reporting burden for this collection of information is estimated to average 60 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-XXXX). Do not return the completed form to this address.

National Cancer Institute Application For X Fellowship

The National Cancer Institute is the Nation's primary agency leading the fight against cancer by supporting and conducting ground-breaking research in cancer biology, causation, prevention, detection, treatment and survivorship. NCI's goal is to stimulate and support scientific discovery and its application to achieve a future when all cancers are uncommon and easily treatable. The NCI works toward this goal by providing vision to the Nation and leadership for thousands of NCI funded researchers across the United States and around the world and working to assure that the results of research are translated into reducing the burden of all cancers for all people.

To begin the application process, specify up to 5 scientific focus area:

Enter the following information:

Name:

Middle Initial:

Last Name:

E-mail Address:

Street Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Department (if applicable):

Affiliation (if applicable):

Citizenship:

Undergraduate Degree GPA:

Completed Education Levels:

Give a brief statement of your research interests and reason for seeking a fellowship at NCI.

Specify your date of availability:

Provide a brief overview of your education experience. List title of positions held, and length of time employed.

Please tell us how you heard about this opportunity (name of school, title of event or conference, advertisement).

Upload your resume and CV here:

Thank you for applying, we will contact you by email if you qualify.

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