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NIDA International Program Drug Abuse Research Fellowships

(Must be completed in English)

IMPORTANT: Write this Passkey Number on a piece of paper immediately and keep it in a safe location. You will need this Passkey Number to access your applicaton to make changes. :

dc38e310-133d-4b46-9e70-515dcb0db9bb
Fellowship Information
Application Type (Select One) *
Applicant Information
First/ Given Name of Applicant *
Last/Family Name of Applicant *
Advanced Degree(s) *
Applicant Year of Birth (yyyy) *
Sex or Gender
Country of Citzenship (list both if dual citizen) *

Phone(xxx-xxx-xxxx) *
Primary E-mail *
Alternative E-mail
Position Title *
Name of Applicant's Institution *
Department, Service, Laboratory, or Equivalent *
Institution Mailing Address *
Permanent Home Address *
 
 
Applicant's References
Colleague/Supervisor : 1 *
Name * (First/Given Name and Last/Family Name)
Email *
Colleague/Supervisor : 2 *
Name * (First/Given Name and Last/Family Name)
Email *
 
 
Mentor Information
Name of Mentor * (First/Given Name and Last/Family Name)

Name of Mentor's Institution *
Institution Mailing Address *

Phone(xxx-xxx-xxxx) *
Mentor's Primary E-mail Address *

 
 
 
Applicant's Personal History
Education- Please list all post-secondary institutions you attended, beginning with the most recent.
Name and Location of Institution

Title(s) of Theses/Dissertations.
Name of Diploma or Degree
Dates Attended (MM/YYYY)
From/ To
1 * *   
Major Field(s) of Study *
Diploma or Degree *
*/ *
2.      
Major Field(s) of Study
Diploma or Degree
/
3.      
Major Field(s) of Study
Diploma or Degree
/
4.      
Major Field(s) of Study
Diploma or Degree
/
 

Additional Training (include NIH-sponsored activities or funding).
Activity
Field
Institution
From-To(MM/YYYY)
1.        /
2.       /
3.       /
4.       /
 
Current Employment
Name and Address of Current Employer* Job Title * Employed From - To (MM/YYYY) Please describe your current job responsibilities. *
* /
Previous Employments
Previous Employer(s)
Job Title(s)
Employment From-To (MM/YYYY)
1. /
2. /
3. /
4. /
 

List your peer-reviewed publications (Recent 10).
  

 

List your significant honors, awards, projects, or other accomplishments.

  

 
 
Applicant's Research Proposal
Fellowship Goals - Please provide a summary of your goals for the fellowship (Limit to  500 characters). *
Research Proposal Abstract - Please limit your abstract to 2000 characters. *


Explain the research opportunities the institution and mentor offer that are not currently available in your home country.
Describe key factors in your selection of your mentor. *

Applicant's Full Research Plan
Applicants must submit a full research plan. Your plan may not exceed three pages not including literature citations. Your plan should include:

 (1) Specific aims
 (2) Background and significance
 (3) Research design and methods
 (4) A statement of assurance that research presented in this application will be conducted in compliance with NIH regulations on the conduct of research.
 (5) Literature citations (Each citation must include the authors' names, book or journal title, volume number, page numbers, and year of publication).

Important Note: If you make any changes to your mentor statement and need to upload a new version, you must use a different name for the revised file. For example, if the file name for your first mentor statement document was SamSmithMentorStatement, the file name for your revised document should be SamSmithMentorStatement2.

Upload your research plan: Only PDF or MS Word Formats are accepted.
 
 
 
Applicant Certification and Acceptance
By checking the box,I,  , declare that I have read and understand the U.S.Federal regulations on the conduct of research supported
by the National Institutes of Health (NIH). I certify that the statements herein are true, complete, and accurate to the best of my knowledge, and I accept the obligation to comply with the terms and conditions if a fellowship is awarded as a result of this application. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties.

An incomplete certification and acceptance section, will disqualify your fellowship application.

          

 

 

 

 

 

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Center for Information Technology • National Institutes of Health • Bethesda, Maryland 20892
Phone: 301-496-4357 • Web: ITServiceDesk.nih.gov