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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. :    ddf44678-ac70-481c-b54c-4e9d8206dcb4
Applicant First/Given Name *:    
Applicant Last/Family Name *:
 Applicant Email *:   
Mentor First/Given Name *:   
Mentor Last/Family Name *:  
Name of Mentor's Institution*

Position and title*

Department, Service, Laboratory or Equivalent*

Office Phone(xxx-xxx-xxxx)*
Office Mailing Address*
Email Address(Primary) *
Email Address(Secondary)
Institution and Location
Degree Completed(MM/YYYY) format
Field of Study
* * *  / * *
List upto 10 of your significant publication, honors, awards, or other accomplishments, including current membership on a Federal Government public advisory committee.
In addition to the applicant, how many pre-doctor and post-doctoral fellows/trainees will be supervised during the fellowship period?
How many pre and post doctoral fellow have you trained?
List up to five of the most recent pre and post doctoral fellows that you have trained (eg: Name / Current Employer / Position Title)
Mentor's statement:
Mentors must submit a statement not to exceed three pages.Only PDF or MS Word formats are accepted. Your statement should include:

1) Describe the Research Plan for the applicant. Include such items as seminars and opportunities for interaction with other groups and scientists. Describe the research environment and available research facilities and equipment. Include information that will help reviewers evaluate the applicant and the proposed research project. Indicate the relationship of the proposed research to the applicant's career. Describe the skills and techniques that the applicant will learn and relate these to the applicant’s career goals.

2) Describe the applicant's qualifications and potential for a research career.

3) Please assess the feasibility of the Research Plan with respect to current NIH regulations on the conduct of research.

4) Please describe the applicant’s understanding of the U.S. Federal guidelines regarding the conduct of research, and how you will ensure that the applicant complies with all NIH and institutional requirements.

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 mentor statement. Only PDF or MS Word formats are accepted.  
Mentor 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.


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