Form 1 TSIF Application

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Guidelines for Application
OMB# 0925-0761
Expiration Date: 07/31/2022
Collection of this information is authorized by The Public Health Service Act, Section 479
(42 USC 287). The information collected in this application will be used to facilitate the
acceptance and onboarding of applicants. Rights of participants are protected by The
Privacy Act of 1974. The information you provide will be included in a Privacy Act
system of records, and will be used and may be disclosed for the purposes and routine uses
described and published in the following System of Records Notice (SORN): 09-25-0014
– Clinical Research: Student Records, HHS/NIH/OD/OIR/OE. Participation is voluntary,
and there are no penalties for not participating or withdrawing at any time. The information
collected will be kept private to the extent provided by law. Names and other identifiers
will not appear in any report. Information provided will be combined for all participants
and reported as summaries.
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 (0925-0761). Do not return the completed form to this address.

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Application Materials
The following application materials are required, as described below:
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Personal statement of research goals
Curriculum vitae
Three letters of reference
Academic transcripts
Other documentation

Personal statement of research goals. In narrative form describe your research interests and
goals and how these relate to the field of WUDQVODWLRQDO science research and research-related to
regulatory and drug development science, and review. Additionally, indicate a potential
project and mentor set of interest from the mentor list found on the TSIF webpage in relation
to your research interests. Please also provide insight into your short- and long-term career
goals, and explain how the 76,) program will help you in achieving those goals. Limit your
personal statement to two typed, single-spaced pages and use 12-point font and 1” margins
(approximately 1,000 words).
Curriculum Vitae. Please refer to Guidelines for Application/Information to
Include in Curriculum Vitae section.
Letters of Reference. Three current and original letters of reference must be sent by
individuals in the scientific/academic community who have knowledge of your scientific
accomplishments, motivation, and skills. Letters should be typed on official letterhead,
addressed to the Program Director, Dr. Jessica Faupel-Badger, and sent electronically to
[email protected].
AcademicTranscripts. Copies of all graduate and undergraduate transcripts
(and/or translations, if applicable) must be submitted directly to [email protected]
Other Documentation. Permanent residents of the United States must submit proof of
eligibility for citizenship. The I-551 stamp in a passport is acceptable; “Employment
Authorization” documents are not acceptable.

Information to Include in Curriculum Vitae
• Applicants are encouraged to use their current curriculum vitae and to add
any necessary information.
• Please include your name on each page of the curriculum vitae.
• Some of the information requested below will not be applicable to all
individuals.
• Please do not print or type your information on this page.

Personal Information
__________________________________________________________
Name (First middle last)
Gender (optional)
Date of birth
Citizenship (U.S. Citizen, Permanent Resident, or Foreign Citizen)
Home address
Work/school address
Preferred Telephone
Fax
E-mail (if more than one e-mail address is provided, please indicate preferred contact)

Education
__________________________________________________________
Please list all colleges and universities attended and any other relevant training. Include
the following information for each institution:
School, department, city and state, country
Dates attended, academic major, degree, year degree awarded/expected
Work Experience
__________________________________________________________
Please list current and past employment. Include the following information for each
position:
Title, employer’s name
Dates of employment
Brief description of duties and accomplishments

Other Information __________________________________________________________
Please note that the list below is not exhaustive and may not be relevant to all applicants.
Board certification
Committees
Grants awarded
Honors and awards
Patents
Peer-review service
Professional licenses
Professional society memberships
Scientific presentations
Teaching
Research Interests
__________________________________________________________
Please provide a few key words that describe your research interests.
Bibliography
__________________________________________________________
Please list all publications and indicate whether they are “published,” “in press,”
“submitted,” or “in preparation.” Please list full-length manuscripts and abstracts
separately.

How to Submit Application Materials
If you are interested in applying to the TSIF program and meet the eligibility requirements,
please submit the following materials:
Personal Statement of Research Goals, and Curriculum Vitae . Please send your
application to [email protected]. Please provide your personal statement of research
goals and curriculum vitae as two separate documents. The application must be submitted on or
before January 15, 2021.
Academic Transcripts, Letters of Reference and Other Documentation. Academic
transcripts, letters of reference, and other documentation materials should be sent directly to
Dr. Jessica Faupel-Badger (refer to Contact Information below). All application materials must
be postmarked on or before January 15, 2021.

Contact Information
Program Email Address: [email protected]
Program Director: Jessica Faupel-Badger, Ph.D., MPH
National Center for Advancing Translational
Sciences 6701 Democracy Boulevard
Room 976
Bethesda, MD 20892-4874
Telephone: 301-827-4342
E-mail: [email protected]

Application Deadline: January 15, 2021
Selection for the fellowship will be based solely on merit, with no discrimination for non-merit reasons, such as race, color,
gender, national origin, age, religion, sexual orientation, or physical or mental disability. NIH and FDA provide reasonable
accommodations to applicants with disabilities. If you need reasonable accommodation during any part of the application and
hiring process, please notify us. The decision on granting reasonable accommodation will be handled on a case-by-case basis.
THE NIH/NCATS AND FDA ARE AN EQUAL OPPORTUNITY EMPLOYER.