Form 11 GSOAR-Alumni Tracking

GRADUATE SUMMER OPPORTUNITIES IN ADVANCED RESEARCH (G‐SOAR) ‐
ALUMNI TRACKING
OMB Clearance Number: 0925-0299
Expiration Date: 30-Jun-2022

GENERAL INFORMATION
First Name (Forename; Given Name):

Last Name (Surname; Family Name):

Personal Email Address (check accuracy):

Permanent Phone Number (check accuracy):

G-SOAR PARTICIPATION INFORMATION
G‑SOAR Participation Year:

NIH Institute‑Center:

NIH Campus Location:

NIH Investigator:

What was the most helpful thing you learned from your internship at NIH?

MASTER UNIVERSITY INFORMATION
MS Degree ‑ University Name:

MS Degree ‑ School / College Name:

MS Degree ‑ Start State

MS Degree ‑ Graduation Date:

MS Degree ‑ Thesis Title:

GRADUATE UNIVERSITY
Graduate University

Graduate School / College Name:

Graduate University Start Date:

Graduate University Graduation Date:

Graduate Degree Awarded:

Graduate Dissertation Title:

CAREER DEVELOPMENT
What is your current professional status?

Which programs have you applied for admission?

Which programs have you been awarded?

Provide information about your training program (non‑degree program):
~ Training Program ‑ Company:

~ Training Program ‑ Mentor:

~ Training Program ‑ Status:

~ Training Program ‑ Dates:

~ Training Program ‑ Description of Research:

What is your long‑term career goal (5‑years or 10‑years beyond graduation):

Submit Survey

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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 30 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.

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