1 Student Application Form

Application Forms for the NIDA Summer Research Internship Program

Attachment 1 - Student Application Form

OMB: 0925-0738

Document [pdf]
Download: pdf | pdf
12/7/22, 10:19 AM

Application

2023 NIDA Summer Research Internship
Program
Application Form
Application Deadline: Friday, February 10,
2023
OMB Control Number: 0925-0738, Expiration Date: 12/31/2022.
Public reporting burden for this collection of information is estimated to average 1 hour 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 current 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 (0925-0738).
Do not return the completed form to this address.

Program:
The NIDA Summer Research Internship Program provides paid internships to support undergraduate students with a focus on
increasing underrepresented populations in substance use and addiction-related research. Through this program, undergraduate
students age 18 years and older are introduced to the field of substance use and addiction research by participating in research
internships with NIDA’s distinguished scientists at universities across the United States. Students work with leading addiction scientists
for eight weeks during the summer. The internship may include laboratory experiments, data collection, data analysis, formal courses,
participation in lab meetings, patient interviews, manuscript preparation, library research, literature reviews, and more. In addition, each
intern will deliver a formal presentation on his/her research project at the end of the internship.
The NIDA Summer Research Internship Program is in its 27th year. Since the program’s inception in 1997, more than 1395 students have
gained experience in substance use and addiction research.
Eligibility:
This program provides experiential summer research internships for undergraduate students from all backgrounds, with a goal of
enhancing the representation of students from underrepresented backgrounds (American Indian/Alaska Native, Black/African
American, Hispanic/Latino, Native Hawaiian/Pacific Islander) in addiction-related research.
Graduating 2023 college seniors are eligible to apply.
Applicants must be at least 18 years old by May 31, 2023 and must be U.S. citizens or permanent residents of the United
States (no exceptions).
Individuals who have already participated in the NIDA Summer Research Internship Program are no longer eligible to apply.
Students must be committed to working for 8 consecutive weeks during the summer (some schedule flexibilities may be allowed).
Scope of Support:
Salary in the amount of $15.00 per hour for a maximum of $4,800 for eight weeks.
Up to $2,500 for housing reimbursement (additional housing support will be considered with proper documentation on a case-bycase basis). Note that neither NIDA nor the research site are responsible for the cost of utility bills, internet, or other expenses
outside of the monthly rent charges. It is expected that the intern will pay for these additional costs, if applicable.
Up to $500 to be used for air and/or local travel (additional travel reimbursement will be considered with proper documentation
on a case-by-case basis).
Housing for On-Campus Internships:
There are two different housing options for the research sites included in the NIDA Summer Research Internship Program: On Campus
Housing and Off Campus Housing. For both options, the housing is funded by NIDA (up to $2,500 with exceptions that will be
considered on a case-by-case basis).
For research sites with the “Campus Housing Available” option, on-campus housing for the duration of the internship will be an
available option and this should be coordinated by the intern and the research site staff. Please note that if the on-campus
housing package includes meals, NIDA will not cover these additional expenses and the intern will be held responsible.
For research sites with the “Off Campus Housing” option, on-campus housing is not available, and the intern will be responsible
for securing their own housing accommodations. Some research sites have off-campus housing resources that you may be able to
request.
Virtual Internship:
Due to the ongoing COVID-19 pandemic, some research sites are offering a virtual research opportunity. If the selected institution has
indicated that they are able to host a student through the virtual model, and this is of interest to the applicant, please select that option
and this information will be relayed to the research site. Due to the short timeframe, it is impossible for the research site or NIDA to
provide a computer; therefore, all interns must have access to a computer, strong internet connection, and a quiet place to work.
Neither NIDA nor the research site is able to pay for the purchase of a computer internet access or any other costs associated with

https://stg19-nidaextshare.sps.nih.gov/SRIP/SitePages/Application.aspx

2/6

12/7/22, 10:19 AM

Application

Neither NIDA nor the research site is able to pay for the purchase of a computer, internet access, or any other costs associated with
conducting a virtual research internship. Arrangements for a virtual internship, as well as the start/end date of your internship, should be
discussed with the research site staff as soon as the student is notified of selection to the program.

Application Procedures:
To apply for this program, complete all sections of the application form. Prior to making your research site selections, review the
research projects and locations listed in the online program guide. After reviewing the descriptions, indicate on the application the three
research sites that best match your research interests and why those sites are of interest to you, being thorough in your justification. All
efforts will be made to match applicants to one of their top three choices.
Application components include:
The full application form
Current transcripts (unofficial transcripts are acceptable)
Two letters of recommendation on letterhead submitted electronically prior to the application deadline. It is the applicant’s
responsibility to ensure that the letters of recommendation are submitted prior to the application deadline.
If any components of the application are missing once the deadline has passed, the application will be considered incomplete and will
not be reviewed.
IMPORTANT: References will be contacted only after an application is submitted. Applicants may modify, save, and submit their
application as often as needed up to the application deadline and the application will be automatically updated each time, but
in order for references to receive notification of a letter request, you must submit the application. Once an application is
submitted, information about references cannot be changed. Again, applicants can continue to edit the other components of
the application until the application deadline.
NOTE: Please make sure to insert the reference’s email address correctly or they will not receive the recommendation letter
request. A day after the application is submitted, applicants should confirm that their references received the automatic email
request. Please contact Julie Huffman ([email protected]) if either reference did not receive the automatic reference
letter request email.
All application materials must be submitted by Friday, February 10, 2023.
Application Review and Selection:
Interns are selected according to the following criteria:
Professional/Career goals
Research interests
Accomplishments, interests, and success
Letters of recommendation
Program Priorities
For additional information see the FAQs.
Contact:
For further information please feel free to contact Julie Huffman, [email protected] , phone 301-443-9798.

Personal Information
First Name
Enter First Name Here..

Email Address
Enter Email Address Here..

Current Address
Enter Current Address..

Permanent Address
Enter Permanent Address..

Do you currently describe yourself as
male, female, or transgender?
Male
Female
https://stg19-nidaextshare.sps.nih.gov/SRIP/SitePages/Application.aspx

Last Name

Date of Birth (MM/DD/YYYY)

Enter Last Name Here..

Enter Date of Birth Here..

Primary Phone

Secondary Phone (optional)

Enter Primary Phone Here..

City
Enter City Here..

City
Enter City Here..

Enter Secondary Phone Here..

State
--Select--

State
--Select--

What sex were you assigned at birth, on
your original birth certificate?
--Select--

Zip
Enter Zip code Here..

Zip
Enter Zip code Here..

Race
American Indian/Alaska Native
Asian
Black/African American

3/6

12/7/22, 10:19 AM

Application

Transgender male

Which of these best describes your
ethnicity (choose one)?

Transgender female

Native Hawaiian/Pacific Islander
White/European American

Another gender identity

--Select--

Prefer not to answer

Refused

How did you learn about this program?

US Citizen or Permanent
Resident

--Select--

--Select--

Academic Information
Current School/University

Current Level

Enter Current School/University Here..

--Select--

Major

Minor (optional)

Enter Major Here..

Enter Minor Here..

GPA Major

Cumulative GPA

Enter GPA Major Here..

Enter Cumulative GPA Here..

Application Components
References
Provide the current contact information for two references. An automatic email request for a recommendation letter will be sent
directly to them when the application is submitted. Reference Letters must be received on or before the application deadline
and are a required part of the application package (no exceptions). Please ensure your references are aware of the application
deadline. It is the applicant’s responsibility to ensure that letters of recommendation are submitted prior to the application
deadline. References should comment on your academic success, career goals, other achievements, and fit for the program.
Letters of recommendation should be on letterhead whenever possible.
Note: Once an application is submitted, information about references cannot be changed. Again, applicants can continue
to edit the other components of the application until the application deadline. Please ensure references are aware of your
request for a letter of recommendation prior to listing them on the application. Please also make sure to insert the
reference’s email address correctly or they will not receive the recommendation letter request. A day after the application
is submitted, applicants should confirm that their references received the automatic email request. Please contact Julie
Huffman ([email protected]) if either reference did not receive the automatic reference letter request email.

Reference 1
First Name
Enter First Name Here..

Reference 2
Last Name
Enter Last Name Here..

Designation/Title
Enter Designation/Title Here..

Organization
Enter Organization Here..

E-mail Address
Enter E-mail Address Here..

C fi E
il Add
https://stg19-nidaextshare.sps.nih.gov/SRIP/SitePages/Application.aspx

First Name

Last Name

Enter First Name Here..

Enter Last Name Here..

Designation/Title
Enter Designation/Title Here..

Organization
Enter Organization Here..

E-mail Address
Enter E-mail Address Here..

C

fi

E

il Add

4/6

12/7/22, 10:19 AM

Confirm E-mail Address

Application

Confirm E-mail Address

Enter E-mail Address Here..

Enter E-mail Address Here..

Relationship

Relationship

--Select--

--Select--

Statement of Research Career Interest
Please submit a statement that describes your interests in substance use and addiction research, career goals, educational plans
beyond your undergraduate studies, and what you hope to gain from this internship (maximum of 3,000 characters).

Accomplishments, Interests, and Successes
Please describe your accomplishments, interests, and successes (maximum of 3,000 characters).

Transcript
Please submit a copy of your current transcript(s). If selected to participate in this program, you may be required to submit official
transcripts.
Choose Files No file chosen

Site Selections
For research project descriptions, please refer to the program guide:
Provide your top three (3) research site choices, by number, in order of preference.
NOTE: There are two different housing options for the research sites included in the NIDA Summer Research Internship Program:
Campus Housing Available and Off Campus Housing. Please see the ‘Housing for On-Site Internships’ program guide for details
regarding housing options and other relevant information. Please denote if housing is or is not needed for each research site that
you select.
Site 1
--Select--

Housing needed?
--Select-Please select if Housing is needed

Site 2
--Select--

Housing needed?
--Select-Please select if Housing is needed

https://stg19-nidaextshare.sps.nih.gov/SRIP/SitePages/Application.aspx

5/6

12/7/22, 10:19 AM

Application

Site 3

Please select if Housing is needed

Housing needed?

--Select--

--Select-Please select if Housing is needed

Site Selection Justification. Please be thorough in your site justifications (maximum of 3,000 characters)
Indicate your interests and justification for selecting each research site. It is important to detail in the application how gaining research experience
in each of the three sites selected will enhance your professional career..

Schedule Conflicts
This internship requires a full-time (40 hours per week) commitment for eight consecutive weeks (You may be able to arrange
some schedule flexibility with your research site, however, generally your schedule should be free of commitments e.g., vacations,
summer classes, jobs, etc.) that conflict with your participation. Prolonged or frequent absences from the internship are not
permitted.
Earliest internship start date

Do you have any schedule conflicts with the time periods of your selected sites?
--Select--

Notice to Applicant
An application is only complete when it has been submitted and all materials, including letters of recommendation, have been
received. Please remember that references will not receive a system generated email requesting a letter of recommendation until
the applicant "submits" their application.
At any time prior to the application due date, you may access your application to enter updates/edits. To retrieve it, click on the
link sent to the email address entered in the application. Complete/update the application and press SUBMIT. Your most recent
electronic submission will be the one recorded in the application system and used during the evaluation period.

Submit

Center for Information Technology • National Institutes of Health • Bethesda, Maryland 20892
Phone: 301-496-4357 • Web: ITServiceDesk.nih.gov
HHS Vulnerability Disclosure

NIH

HHS

US Gov

https://stg19-nidaextshare.sps.nih.gov/SRIP/SitePages/Application.aspx

6/6


File Typeapplication/pdf
File Modified2022-12-12
File Created2022-12-07

© 2024 OMB.report | Privacy Policy