MHRT 2022 - Application form
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Last Name, First Name *
Email address (institutional) *
Email address (alternative) *
Date of Birth *
Telephone *
Street Address *
City *
State *
Zip code *
Permanent Address (if different)
Colleges Attended, Dates, and Degrees Obtained *
Specify the name and location of colleges attended, dates attended, degree(s) earned, major(s)
Relevant Experience *
Research training or other relevant experience. In the case of research experience make sure you state the discipline, the institution, mentor, dates of training, and publications or communications to conferences. (350 words maximum)
About Yourself *
About Research and your Future *
Explain the role that research will play in your future career. State the highest degree you are planning to earn.
First Choice - Professor/Institution *
Second Choice - Professor/Institution *
Third Choice - Professor/Institution *
Fourth Choice - Professor/Institution *
If you are selected as a finalist we will do every effort to place you in one of your chosen locations. However, this is not always possible. Would you consider choices other than those you specified above? *
Citizenship *
Eligibility based on RFA-MD-18-007 (https://grants.nih.gov/grants/guide/rfa-files/rfa-md-18-007.html). Trainees must be citizens or non-citizen nationals of the United States, or have been lawfully admitted to the United States for permanent residence.
Group Underrepresented in Biomedical, Behavioral, Clinical and Social Sciences Research
Current Student Status *
Trainees must be undergraduates, eligible post-baccalaureates, or graduate students in the life, physical, or social sciences; or medical students, dental students, or students in other health-professional programs who have not yet received terminal degrees. If you are accepted to a higher degree program state it under "other"
Expected graduation date and degree if you are a student
Describe any kind of funding you have received *
Describe any kind of current funding (specify if you will still have it at the time of the MHRT training) *
Major or field of study *
Check all that apply
Specify if you answered "Other" in the previous question (Major or field of study)
Career plans *
Check all that apply
Specify if you answered "Other" in the previous question (Career plans)
List the names, email, telephone, and address of the two references that will complete the Recommendation Forms *
Inform the persons that will write recommendations that they should do so on line at https://docs.google.com/forms/d/e/1FAIpQLSeR9QBOCMbm-yTBB8QSJI4AifNXLnl3FfZOPsSHIx_w9BDdVw/viewform
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