Application for Butler-Williams Scholars Program, 2019

Privacy Act Notification Statement

Collection of this information is authorized under 42 U.S.C. 241. The primary use of this information is to 1) identify candidates for clinical and research fellow, clinical elective, and other training positions, and 2) maintain a permanent record for historical and reference use of those individuals who have received clinical research training at the National Institutes of Health. This information may be disclosed to researchers for research training purposes, to hospitals and other healthcare institutions seeking verification of training for physicians who trained in NIH clinical programs and in response to Congressional inquiries. Submission of this information is voluntary, however, in order for us to accept you as a potential Clinical and Research Fellow, Dental/Medical Student, Postbac/Postdoc Researcher, Summer Intern, or other student seeking an opportunity in an NIH training program, you should complete all fields.

Location: Bethesda, MD

Date: July 29-August 2, 2019

Application Deadline: March 22, 2019

Eligibility: Qualified applicants must hold a doctoral degree (Ph.D., M.D., etc.). Only applicants working in the field of aging or actively considering this research field will be considered.

To Apply:
Please complete and submit the application form below, then send the required supporting documents by email for your application to be complete. See the "Submit Supporting Documents" instructions below the application form and please follow them carefully.

First name

Middle initial

Last name

Degree

M.D.

Ph.D.

Other (please specify below)

Preferred mailing address location

Home

Work

May we distribute your contact information to speakers and participants?

Yes

Institution Name

Street address line 1

Street address line 2

City/Town

State

ZIP/Postal Code

Home phone

Work phone

Fax

Confirm email

With your application, we will add you to an NIA email list for information about other training and funding opportunities.

Position

Faculty

Post-Doctoral Trainee

Other (please specify below)

Are you a US Citizen, Permanent Resident, or Non-citizen National?

Yes

Discipline

Research Interests

Ethnicity

White (non-Hispanic)

Black (non-Hispanic)

Asian (Chinese, Japanese, Korean, Taiwanese, etc.)

Hispanic/Latino

Native American

I prefer not to answer

Other (please write in below)

References

Name of Reference 1

Name of Reference 2

Submit Supporting Documents

To complete your application, please submit the following 5 documents by email to NIABWSP@mail.nih.gov. Include your full name in the subject line and be sure to name your documents using the instructions below. Sending the documents in a single email is strongly preferred if possible.

The following files MUST be received by the application deadline (March 22) for your application to be considered:

Statement describing your objectives in attending the B-W Scholars Program (150 words or less)
Specific aims
Two letters of recommendation from professional references addressing the applicant's demonstrated ability and commitment to future research in the field. Please indicate who will be submitting references for you in the "References" section above.
Biosketch (in NIH format)

Attention:

Your 5 documents (Personal Statement, Specific Aims, Two Letters of Recommendation and Biosketch) must be uploaded at the time of submission for the application to be complete. Successful applications will not be reviewed without the supporting documents.

Please name your files using this format before sending:

lastname_firstname_statement.[ext]
lastname_firstname_aims.[ext]
lastname_firstname_rec1.[ext]
lastname_firstname_rec2.[ext]
lastname_firstname_bio.[ext]

Example: one of Dr. Jane Doe's recommendations should be named doe_jane_rec1.pdf

Acceptable file formats are: PDF, MS Word (.doc, .docx, or .rtf), or plain text (.txt).