Form 27 Academy Enrichment Application

NIH ACADEMY ENRICHMENT PROGRAM APPLICATION

OMB Clearance Number: 0925-0299
Expiration Date: 30-June-2022
This application is solely for consideration to the NIH Academy Enrichment Program - current NIH Postbacs
are not eligible.

Indicate your current status:*

First Name (Given Name):*

Last Name (Family Name):*

NIH or University E-mail Address:

(check accuracy)
Permanent E-mail Address:

(check accuracy)
Letter of Interest:

(Limit the size of your letter to no more than two-pages single spaced.)

Describe your specific career goals and how a year (or two) of research at NIH will help you reach
those goals.

Briefly discuss how events in 2020 have impacted your life and/or community.

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

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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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