Form 1 2021 GPSF-Exhibitor Registration

GRADUATE & PROFESSIONAL SCHOOL FAIR - 2021 VIRTUAL - EXHIBITOR
REGISTRATION
OMB Number: 0925-0740
Expiration Date: 31 Jul 2022
The Virtual 2021 National Institutes of Health Graduate & Professional School Fair will be held from July
19th through July 22nd. The online exhibits will be held on July 20th through July 22nd. By completing
this survey, you are letting us know that you plan to exhibit. Selecting a date at this time is not a
commitment for that date, it is for our planning purposes. On May 3rd, exhibitors that RSVP will be
given instructions on how to select a specific session time slot, create an online meeting, and share their
session plan with us. We will include your meeting information on our webpage and share a compiled
list of online meeting information with registered students and NIH postbacs.
This fair will provide an opportunity for representatives of graduate and professional schools to meet
and recruit up-and-coming young scientists taking part in the NIH Postbaccalaureate Program and other
college and university students. Student interest is highest in the following schools/programs: medical
school, graduate school (PhD programs in all the biomedical sciences), MD/PhD programs, public health
programs, psychology, dental school, nursing school and pharmacy school.
Questions?
Jackie Newell-Hunt
NIH O!ce of Intramural Training & Education
[email protected]
Web: https://www.training.nih.gov

POINT OF CONTACT (POC) FOR THIS REGISTRATION
Title*

First Name (Given Name):*

Last Name (Family Name):*

Institution / University:*

Position Title:*

Email Address (check accuracy):*
We cannot guarantee your participation if you fail to provide a functioning email address. A confirmation
email message containing this registration will be sent to the email account listed within 2-hours of
submission.

Phone Number:*
ex: 123-456-7890

INSTITUTION / UNIVERSITY INFORMATION
Institution or University Name (complete name):*

Program or Department you are representing (complete name):*

Program Website (include http:// or https://):*

Name of the training program as it will appear in the event program, limit 100 characters, be
specific. We will not insert your university name if you omit it. We recommend that you list the
university first. If you attended last year, you will be able to find the name of your program at
https://www.training.nih.gov/gp_fair_institutions.*
Example: "University of Alabama Dental School" or "Baylor University Graduate Program in Biophysics"

This registration is for which type of program?*
Select all that apply.
Dental
Graduate
Medical
MD/PhD
Pharmacy
Psychology
Public Health
Nursing
Other

If you selected "Other" for the Registration Type, please specify in the space provided:

Preference of Online Exhibit Meeting - Date:*
(This is not a commitment.)

Preference of Online Exhibit Meeting - Duration:
(This is not a commitment.)

ONLINE MEETING INFORMATION
Online Exhibit Meeting - Date

Online Exhibit Meeting - Time (include Time Zone):

Online Exhibit Meeting - URL Address:

Online Exhibit Meeting - Meeting ID

Online Exhibit Meeting - Pass Code:

Brief Description of Your Online Meeting (Limit 280 Characters)

Who will represent your program?
-

Recruiters / Admnistrators
Program Directors
Faculty Members
Current Students
NIH Postbac Alumni
Others

What will be your online meeting format?

-

Questions & Answers
Presentation (Shorter Than 30 Min)
Presentation (Longer Than 30 Min)
Breakout Rooms
Other

The online exhibitor session will be recorded and made available for later viewing.
Please note that, some states require that individuals be notified in advance if they will be recorded.
Please make certain to alert participants in your session to your intention to record it.
Yes

No

Online Exhibit Meeting Other Information:
(optional)

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
submission. 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 0925-0740. Do not return the completed form to this
address.

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