Form 1 Biosketch Reinstatement

OMB No. 0906-0048 (Approved Through 03/31/2023)

BIOGRAPHICAL SKETCH

Provide the following information for the Senior/key personnel and other significant contributors.
Follow this format for each person. DO NOT EXCEED FIVE PAGES.

NAME:

eRA COMMONS USER NAME (credential, e.g., agency login):

POSITION TITLE:

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable. Add/delete rows as necessary.)

INSTITUTION AND LOCATION	DEGREE (if applicable)	Start Date MM/YYYY	Completion Date MM/YYYY	FIELD OF STUDY

Please provide race and ethnicity data for the Principal Investigator (Unused columns and/or rows may be deleted):

Racial Categories	Ethnic Categories
	Not Hispanic or Latino			Hispanic or Latino			Unknown/Not Reported Ethnicity			Total
	Female	Male	Unknown / Not Reported	Female	Male	Unknown/ Not Reported	Female	Male	Unknown/ Not Reported
American Indian/ Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
More than One Race
Some Other Race
Unknown/Not Reported
Total

Please provide race and ethnicity data for the program’s key staff. Only one chart is needed for the entire staff. Include this chart either with the PI’s biosketch or in the biosketch of the first Key Personnel (Unused columns and/or rows may be deleted):

Racial Categories	Ethnic Categories
	Not Hispanic or Latino			Hispanic or Latino			Unknown/Not Reported Ethnicity			Total
	Female	Male	Unknown/ Not Reported	Female	Male	Unknown/ Not Reported	Female	Male	Unknown/ Not Reported
American Indian/ Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
More than One Race
Some Other Race
Unknown/Not Reported
Total

A. Personal Statement

B. Positions and Honors

C. Contributions to Science

Public Burden Statement: 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. The OMB control number for this project is 0906-0048. Public reporting burden for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.