2 Form

PHS Applications and Pre-award Related Reporting (OD)

Attachment 7C PHS 416-1 face page 2

416-1

OMB: 0925-0001

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KirschsteinNRSA Individual Fellowship Application

(To be completed by the Applicant – follow PHS 416-1 instructions)

NAME OF PD/PI CANDIDATE (Last, first, middle initial)

     

SPONSOR and Co-Sponsor Information

15. NAME OF SPONSOR

16. NAME OF Co-SPONSOR (When applicable)

15a. NAME AND DEGREE(S)

     

16a. NAME AND DEGREE(S)

     

15b. ERA COMMONS USER NAME

     

16b. ERA COMMONS USER NAME

     

15c. DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT

     

16c. DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT

     

15d. MAJOR SUBDIVISION

     

16d. MAJOR SUBDIVISION

     

15e. Address:

     

16e. Address:

     

Telephone:

     

Telephone:

     

Fax:

     

Fax:

     

E-Mail:

     

E-Mail:

     

RESEARCH PROPOSAL

17. DESCRIPTION: See instructions. State the application’s broad, long-term objectives and specific aims, making reference to the health relatedness of the project (i.e., relevance to the mission of the agency). Describe concisely the research design and methods for achieving these goals. Describe the rationale and techniques you will use to pursue these goals.


In addition, in two or three sentences, describe in plain, lay language the relevance of this research to public health. If the application is funded, this description, as is, will become public information. Therefore, do not include proprietary/confidential information. DO NOT EXCEED THE SPACE PROVIDED.

     

PHS 416-1 (Rev. 07/2024) Page 2 Number pages consecutively at the bottom throughout Form Page 2
the application. Do not use suffixes such as 2a, 2b.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitlePHS 416-1fp2 (Rev. 8/12), Form Page 2
SubjectRuth L. Kirschstein National Research Service Award Individual Fellowship Application
AuthorDHHS, Public Health Service
File Modified0000-00-00
File Created2024-09-26

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