Form 3 Diversity Summer Research Training Program (DSRTP) Appli

5/19/2016

Login/Register ­ DSRTP

OMB #0925-XXXX
Expiration Date: XX/XXXX
Diversity Summer Research Training Program (DSRTP) Application
Public reporting burden for this collection of information is estimated to average 45 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-xxxx*). Do not return the completed
form to this address.

NIDDK
Home

Diversity Summer Internship Program for Undergraduate Students

Login/Register

Login/Register
For New Student
Take me to the Registration Page
For Returning Student
User Name
Password
Log In
Having Trouble?
Help! I forgot my password
Help! I forgot my Login ID

Contact NIDDK

|

NIDDK Privacy Statement

U.S. Department of Health and Human Services

https://dsrtp.niddk.nih.gov/Account/Login

|

|

Accessibility

|

Copyright Status

National Institutes of Health

|

USA.gov – Government Made Easy

1/1

Program

Diversity Summer Research Training Program (DSRTP)

# 6524

Your Review
Rank

Update Application

0

Review Comments

Print Application

Personal Information
Current Pro慠le
Name
Address
Contact Numbers

Day Phone:
Cell Phone:

Home Phone:

Veteran?
Citizenship Status
Prior NIH Experience?
Prior Research Experience?

Relative at NIH?
Research Location
Future Contact
Name
Address
Contact Numbers
Email

Demographics
Date of Birth
Gender
Hispanic?
Race

Family Income
Are you applying based only on disadvantaged background?

Other Financial Aid

Academic Information
Enrolled At
Current Grade
GPA / Scale
Academic Major
Course Work

Graduation Month, Year

Resume/CV
EDUCATION

WORK EXPERIENCE

PROFESSIONAL MEMBERSHIPS

Employment & Volunteer Experience

Honors & Awards

Extracurricular Activities

References
Reference# 1
Characteristics
Intellectual Capacity (Ability to comprehend, integrate and work
with a large quantity of information):
Motivation (Genuineness and depth of commitment to science
and biomedical research):
Interpersonal Relations (Ability to get along with others,
rapport, cooperation, attitude towards supervision):
Analytical Skills (Ability to solve problems, correlate and
process information and think critically):
Judgement (Ability to evaluate a problem and make logical and
sound decision):
Reliability (Dependability and sense of responsibility):
Autonomy (Ability to function and think independently; self
governing):
Verbal Communication Skills (Clarity, ability to articulate):
Written Communication Skills (Clarity and conciseness of
written expression):
Persistence (Perseverance to completion of a task):
Integrity (Honesty, trustworthiness):

Ratings

Innovative (Creative, novel approaches):
Overall Rating
Reference Letter (click to download):
The recommendation was submitted on:

Reference# 2
Characteristics

Ratings

Intellectual Capacity (Ability to comprehend, integrate and work
with a large quantity of information):
Motivation (Genuineness and depth of commitment to science
and biomedical research):
Interpersonal Relations (Ability to get along with others,
rapport, cooperation, attitude towards supervision):
Analytical Skills (Ability to solve problems, correlate and
process information and think critically):
Judgement (Ability to evaluate a problem and make logical and
sound decision):
Reliability (Dependability and sense of responsibility):
Autonomy (Ability to function and think independently; self
governing):
Verbal Communication Skills (Clarity, ability to articulate):
Written Communication Skills (Clarity and conciseness of
written expression):
Persistence (Perseverance to completion of a task):
Integrity (Honesty, trustworthiness):
Innovative (Creative, novel approaches):
Overall Rating
Reference Letter (click to download):
The recommendation was submitted on:

Personal Statement

Privacy&Act&Noti)ication&Statement
Collection of this information is authorized under 42 U.S.C. 241 and 5 U.S.C. 301. The primary use of this information is to provide short-term research
education for high school and undergraduate students from racial and ethnic minority or disadvantaged backgrounds in order to expose them to
research within the mission of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH)
and to determine their eligibility to receive grants. This information may be disclosed to NIH administrators, NIDDK Diversity Summer Research Training
Program (DSRTP) staff, university reviewers, and DSRTP review committee members for administrative and educational purposes. Submission of this
information is voluntary, however, in order for us to consider you for enrollment in the DSRTP program and potential grant funding, you should complete
all the required fields.