Regulatory Science Application

Contact Information

Regulatory Science Internship Program
Application Form

First Name:

Last Name:

MI:

Address:
City:

Apt/Suite:
State:

Zip Code:

Email:
Phone:
Education
The degree that I am currently pursuing is a:_____________________________________
Educational Institution:
Major/Field of Study:
Expected Completion Date (MM/YYYY):
Research Interests
Select up to three regulatory science priority interest areas. To learn more about these priority areas, visit FDA.gov.
#1
#2
#3
If you selected Other, please select up to three fields of interest.
#1
#2
#3
In 250 words, explain why you are interested in a Regulatory Science internship at the FDA.

Applicant Signature

Date

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maintaining the necessary data, and completing and reviewing the collection of information. Send comments regarding
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An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
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approved under the OMB Control No. 0910-XXXX and expires XX XX, 20XX.