Form 1 Community College Day Registration - student

feedback - Office of Intramural Training & Education at the National Institutes of Health

8/10/21, 11:05

2021 NIH VIRTUAL COMMUNITY COLLEGE DAY - REGISTRATION FORM
OMB Number: 0925-0740 (Expiration Date: 31 July 2022)

Type of Attendee:*
Student

First Name (Given Name):*

Last Name (Family Name):*

Email Address:*
(Check Accuracy)

College Name
other

College Name (if 'Other' was selected above):

College Location (State):

How did you learn about the Community College Day?
other

How did you learn about Community College Day? (please specify)

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.

Submit Survey

Cancel

https://www.training.nih.gov/sas/_20/2178/OITE?

Page 1 of 1