PRS Workshop Application Form Full Name Degree MDPhDMD/PhDDOother Institution Department/Division Academic Rank Clinical FellowPostdoctoral ScientistAssistant Professorother Years in Rank 12345 Email Address Phone Gender malefemalenon-binaryprefer not to answer Are you a member of a community Underrepresented in Health Related or Scientific Fields? For more information on this, please visit NIH Diversity Criteria. yesno Please outline plans for upcoming grant submissions Applicant Curriculum Vitae Should emphasize accomplishments towards a research career and in PDF or Word format. Letter of Nomination Usually by a PRS Member, Mentor, Division Head, Department Chair, or a supervisor who can indicate how the candidate will benefit from attending the meeting and Workshop (including plans for upcoming grant submissions) and in PDF or Word format. Statement on institution letterhead confirming institutional support for travel expenses to attend the meeting. NOTE - if travel expenses requirement cannot be met - some funds may be available. Please indicate if your department cannot pay travel funds and PDF or Word format. After hitting submit, DO NOT close your browser until you see a notification below that your application has been received.