31 GPP Registration

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GRADUATE PARTNERSHIPS PROGRAM
MY CONTACT INFORMATION
OMB No. 0925-0299
Expiration Date 06/30/2022

Contact Information
Enter your contact information in the fields provided. Carefully review your information prior to submission to
ensure accuracy. Inaccurate information may adversely a!ect your application to the NIH/OITE Graduate
Partnerships Program (GPP).
Select

Name:

Prefix

First

MI

Last

Email Address:
Permanent Home Phone:
Permanent Address:
Address Line 2:
City:
State:
(Use DC for District of Columbia and NA if your permanent address is not in the U.S.)
Zip/Postal Code:
Country/Region:

United States

Citizenship Status:

US Citizen

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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.
Public reporting burden for this collection of information is estimated to average 60 minutes 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 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 (0925-0299). Do not return the completed form to this address.

Go

home

for prospective applicants

GRADUATE PARTNERSHIPS PROGRAM
REGISTRATION FORM (SHORT FORM)

RETURN TO MYGPP | SIGN-OFF

OMB Clearance Number: 0925-0299
Expiration Date: 30-June-2022

Instructions: Before you begin, you may want to review some helpful hints on using this electronic form and our privacy statement.
Eligibility Criteria:
You must be classified as a matriculant of one of the following NIH-University Institutional Partnerships to complete the NIH/OITE
Graduate Partnerships Program (GPP) Application for an Institutional Partnership.
Individual Partnership
Centro de Neurosciencias de Valparaiso, Chile - Neuroscience / NINDS
Charles University, Czech Republic - Biomedical Research / NICHD
Chinese University of Hong Kong - Biomedical Research / NICHD
Consortia of Hungarian Universities - Biomedical Research / NIAAA
George Washington University - Epidemiology / NCI-DCEG
Johns Hopkins University - Epidemiology / NCI-DCEG
Karolinska Institute (Sweden) - Neuroscience
Taipei Medial University & China Medical University - Neuroscience / NIDA
University of Maryland, College Park - Partnership for Integrative Cancer Research / NCI
University of Maryland, College Park - Sensory and Communication Neuroscience / NIDCD
University of Montana - Molecular Basis for Infectious Diseases / NIAID-RML
University of Pennsylvania - Immunology / NCI
Wellcome Trust Program / NIH
Application Tips:
This form allows you to save a partially completed application. To take advantage of this feature:
Enter as much information into the form as you would like.
Press "Save Partial Application & Quit" to save the information you have entered thus far. You will have to return later to complete
your application.
When you first submit your partial application, you will receive an email message containing instructions for accessing the online
tool that allows you to review, modify, and complete your application. Save this email and follow the directions to complete your
application.
Only COMPLETE applications are available for review by NIH investigators and administrators; partial applications are not accessible by
NIH investigators. Once you complete your application, press "Preview Completed Application." You will be taken to a page displaying
the information you have provided. To submit your completed application, you must select the "Save" button on the Preview
page.

1. Please read the "Graduate Partnerships Program" page before beginning your online application.
2. Be sure that the email addresses you provide are accurate. Incorrect email addresses will delay the processing of your registration.
3. Please note that this form accepts plain text inputs only. This means that special characters and formatting such as bullets, "smart
quotes," bold or italic fonts, Greek letters, etc., will be lost or altered. To ensure your data appear as you intend, compose your
inputs to the longer fields on this form using a plain text editor (e.g., Notepad for PC users or TextEdit for Mac users). In place of
special formatting, you will need to rely on the use of capital letters, white space, asterisks, and other standard keyboard

characters.
4. Proofread your registration thoroughly for accuracy and completeness; false or inaccurate information may be grounds for denying
your candidacy or removing you from the program.
Note: All sessions will automatically expire after 30 minutes of inactivity. To prevent losing your changes please save your application
frequently or submit your application within 30 minutes.
Indicates a required field.

Partnership
This is the NIH/OITE/GPP application for students that matriculated through one of the following NIH-University
partnerships. If you are not a matriculant into one of these partnerships, do not complete this form.
Partnership Type:

Academic Information
Provide information about your PhD program and professional degree program, if applicable.
PhD Degree Academic Information
This section is required.
College/University Name:
Start Date:
Anticipated Graduation Date:
Major Field of Study:
University Mentor 1:
University Mentor 2:

(if applicable)

Have you been awarded or are you currently working towards an MD, DDS, DVM, or RN degree?
Yes

No

NIH Training Information
The information required below is about the NIH Investigator for dissertation research and NOT the University Professor.
NIH Institute-Center:
NIH Mentor 1:

(Tenured / Tenure-Track NIH Investigator)

NIH Mentor 2:

(if applicable)

Start Date at NIH as a Graduate Student:
Anticipated Duration of Training:
NIH Administrative Officer:

Additional Information
Please enter any additional information. (Up to 1500 characters)
Please do not place hard returns at the end of each line - it is only necessary at the end of paragraphs. The open text fields are
designed to automatically wrap text.

How did you hear about this program? (Please select all that apply.)
Ad in a scientific journal (Nature, Science); please specify:
Ad in a student journal; please specify:
Ad in a meeting program
Exhibit at a meeting; please specify:
Career development/opportunities workshop
Flier
Poster
From a mentor or advisor
From an alumnus/alumna of the program
NIH representative visited school
Web search
Other; please specify:

Notice to all applicants:
It is your responsibility to ensure that all of the above information is correct. False or inaccurate information contained in this
application or provided during an interview may be grounds for denying your candidacy or removing you from the program.
Failure to wait for the confirmation webpage will result in an unsuccessful upload. Please be patient.

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.
Public reporting burden for this collection of information is estimated to average 15 minutes 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 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 (0925-0299). Do not return the completed form to this address.