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GRADUATE & PROFESSIONAL SCHOOL FAIR - 2021 VIRTUAL - STUDENT
REGISTRATION
OMB Number: 0925-0740 (Expiration Date: 31 Jul 2022)
Public reporting burden for this collection of information is estimated to average 3-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.
First Name (Given Name):*

Last Name (Family Name):*

Email Address:*
(check accuracy)

My current position can best be described as:*

If you are an 'NIH Trainee', which Institute-Center are you a!liated?

If you are NOT currently training at NIH, please provide the name of your current educational
institution in the space provided.
(complete name, no acronyms)

What types of graduate (PhD and/or MS degree programs) and/or professional (e.g., medical,
dental, pharmacy, etc.) schools interest you?
(select all that apply)
Dental
Graduate
Medical

MD/PhD
Pharmacy
Psychology
Public Health
Nursing
Other
If 'other', please specify:

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