Form 1 TD Faculty Panel Registration form

NINDS Strategic Plan 2021-2026: Training & Diversity Taskforce

Faculty Discussion Panel Meeting Registration

Topic: NINDS Strategic Planning Panel regarding Training and Diversity

Description: The National Institute of Neurological Disorders and Stroke (NINDS) discussion panel on the topic of Training and Diversity. The discussion will be moderated by Dr. Michelle Jones-London, the Director of the NINDS Office of Programs to Enhance Neuroscience Workforce Diversity, and Dr. Stephen Korn, the Director of the NINDS Office of Training and Workforce Development. This panel, together with several others, is being held to help inform the new NINDS Strategic Plan which is currently under development. Attendees will provide important input on approaches by which NINDS can enhance training, mentorship and diversity of the workforce. Information regarding the overall strategic planning process and the discussion panels can be found on our website: https://www.ninds.nih.gov/About-NINDS/Strategic-Plans-Evaluations/Strategic-Plans/NINDS-Strategic-Planning.

OMB#: 0925-0740 Exp Date: 07/2022

Public reporting burden for this collection of information is estimated to be 5 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 29892-7974, ATTN: PRA (0925-0740). Do not return the completed form to this address.

Required fields are marked with an asterisk (*)

1. Name* [fill-in answer]

2. E-mail Address* [fill-in answer]

3. Primary Affiliation* [fill-in answer]

4. Have you ever applied for funding from the National Institute of Neurological Disorders and Stroke (NINDS) or participated in an NINDS-funded program?* [Choose one]

   1. Yes

   2. No

5. Have you ever attended a Minority-Serving Institution (MSI)?* [Choose one]

   1. Yes

   2. No

   3. Prefer not to answer

6. What is your sex? [Choose one]

   1. Male

   2. Female

7. Which of these best describes your ethnicity [Choose one]

   1. Hispanic or Latino

   2. Not Hispanic of Non-Latino

8. Which of these best describes your race? [Choose one or more]

   1. American Indian or Alaska Native

   2. Asian

   3. Black or African American

   4. Native Hawaiian or Other Pacific Islander

   5. White

9. Do you have a disability as defined as a physical or mental impairment that substantially limits one or more major life activities? [Choose one]

   1. Yes

   2. No

   3. Prefer not to answer

10. Do you require any accommodations in order to participate in this virtual meeting (e.g., closed captioning)?* [fill-in answer]

11. Please select two of the Deeper Dive Break-out discussion groups below.* [Multiple Choice]

    1. Break-out 1: What are the programs and policies that NINDS could implement to promote diversity, inclusivity, and cultural competence? How do we communicate and foster the value of diversity across all programs and career stages?

    2. Break-out 2: How does NINDS strengthen training in principles of rigorous research, experimental design, and quantitative skills?

    3. Break-out 3: What could NINDS do to facilitate better mentorship?