8 Amgen Alumni Tracking

AMGEN SCHOLARS AT NIH ALUMNI ‐ WHERE ARE YOU NOW?
OMB Clearance Number: 0925-0299
Expiration Date: 30-Jun-2022

First Name (Forename; Given Name):

Last Name (Surname; Family Name):

Email Address (check accuracy):

What year did you participate in the Amgen Scholars at NIH program?

Are you currently attending Graduate or Professional School or are you planning to begin
in fall 2018?

What school will you be or are you attending?

What academic field will you be studying?

What degree are you pursuing?

When do you anticipate graduating?

If you are not in school, where do you work or study now?

What is your current career goal?

Are you conducting research in your current position?

If yes, what is the area of research?

Have you applied for any scholarships or fellowships?

If yes, please specify which scholarships, fellowships, or programs.

Have you been awarded a scholarship or fellowship? Please specify:

Have you returned to the NIH after your Amgen Scholars internship?

If you have returned to the NIH, to what position did you return?

If you returned as an IRTA, how long did you stay?

If you have any publications, please list below.

If you participated in a national conference(s), please list below.

If you participated in an international conference(s), please list below.

Did you receive funding as a result of your Amgen Scholar internship?

Please list your achievements.

What was the most helpful thing you learned from your Amgen Scholars experience at the
NIH?

Are there any other comments you would like to share with us?

Thank you so much for taking the time to answer our questions! Your feedback is very
important to us and highly appreciated!

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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.

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 currently

valid 0MB 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 (0925-0299). Do not return the
completed form to this address.

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