Regulatory Science Internship Program - Application

Contact Information

Regulatory Science Internship Program
Application Form

First Name:

Last Name:

MI:

Address:
City:

Apt/Suite:
State:

Zip Code:

Email:
Phone:
Education
The degree that I am currently pursuing is a:_____________________________________
Educational Institution:
Major/Field of Study:
Expected Completion Date (MM/YYYY):
Research Interests
Select up to three regulatory science priority interest areas. To learn more about these priority areas, visit FDA.gov.
#1
#2
#3
If you selected Other, please select up to three fields of interest.
#1
#2
#3
In 250 words, explain why you are interested in a Regulatory Science internship at the FDA.

Applicant Signature

Date

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one hour per response, including time for reviewing instructions, searching existing data sources, gathering and
maintaining the necessary data, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspects of this information collection to PRAStaff@fda.hhs.gov.
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. Information collected for the Regulatory Science Internship Program is
approved under the OMB Control No. 0910-XXXX and expires XX XX, 20XX.