Please complete (type) all fields of this application, print out, and submit with a copy of your curriculum vitae and three letters of recommendation (in signed, sealed envelopes). If you choose, you may also submit up to three publications, papers, or abstracts.
Also submit a brief personal statement (3-5 pages) summarizing: 1) why you are pursuing post-doctoral training; 2) your research interests in neurodevelopmental disorders; 3) your professional goals; and 4) your objectives for this post-doctoral training experience.
Deadline to submit applications is April 1, 2009, or until all positions filled.
Trainees are required to pursue their research training on a full-time basis, devoting at least 40 hours per week to the program. Within the 40 hours per week training period, research trainees in clinical areas must devote their time to the proposed research training and must confine clinical duties to those that are an integral part of the research training experience.
Citizenship. To be appointed to a training position supported by an NRSA research training grant, an individual must be a citizen or noncitizen national of the United States or must have been lawfully admitted for permanent residence (i.e., in possession of a currently valid Alien Registration Receipt Card I-551, or must be in possession of other legal verification of such status). Noncitizen nationals are generally persons born in outlying possessions of the United States (e.g., American Samoa and Swains Island). Individuals on temporary or student visas are not eligible.
Postdoctoral Trainees. Postdoctoral trainees must have received, as of the beginning date of the NRSA appointment, a Ph.D., M.D. or comparable doctoral degree from an accredited domestic or foreign institution. Eligible doctoral degrees include, but are not limited to, the following: D.D.S., D.M.D., D.O., D.V.M., O.D., D.P.M., Sc.D., Eng.D., Dr. P.H., D.N.Sc., D. Pharm., D.S.W., and Psy.D. Documentation by an authorized official of the degree-granting institution certifying all degree requirements have been met prior to the beginning date of training is acceptable.
Name (Last, First, Middle Initial)
Mailing Address Phone ()
Permanent Home Address (if different from above)
Phone ()
E-mail address
FAX ()
Gender Male Female
Birthdate
Birthplace (city, state, country)
Citizenship U.S. non-citizen national of the United States? permanent US resident eligible to work in the United States? Other (please specify) Social Security #
To meet NIH reporting requirements, please fill out Part 1 and Part 2 below.
Part 1. Ethnic Category Hispanic or Latino Not Hispanic or Latino Unknown or do not wish to report
Part 2. Racial Categories American Indian/Alaska Native Asian Native American or other Pacific Islander Black or African American White More than one race Unknown or do not wish to report
How did you hear about this training program?
Education: List all colleges, universities, graduate, and professional schools you have attended.
References. Identify the persons you have asked to complete recommendation letters.
1. 2. 3.
Have you ever had a postdoctoral research fellowship? Yes No
What is your current position and place of employment or study?
What type of research would you like to do during this Postdoctoral Training Program?
What Training Program faculty member(s) would you most like to work with? (Click here to view faculty list.)
Title of your dissertation
Status in doctoral program (If not complete, anticipated graduation date)
________________________________________________________________________________ Signature,
[Post-Doctoral Training Program]