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.

    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.