This is not a required form for the TBS TL1 Application. The interest form should be completed to learn more about the program and what is needed.
After completing this form, you will need to provide a draft of the applicant's and primary mentor's NIH biosketch and your project's Specific Aims. More details will be shared in an email once the form is complete.
The final TBS TL1 Application will be due May 1, 2023.
Last Name
* must provide value
First Name
* must provide value
Email Address
* must provide value
Phone Number
* must provide value
Work Address
* must provide value
eRA Commons Username
* must provide value
Yes Do not have one yet
eRA Commons Username
* must provide value
ORCID ID Username.
Link to create ORCID ID: https://orcid.org/register
* must provide value
Yes
No
ORCID ID Username
* must provide value
Status of Citizenship
* must provide value
US Citizen Permanent Resident (Green Card holder) Other
Please explain.
* must provide value
Institution
* must provide value
Georgetown University
Howard University
MedStar
Oak Ridge National Lab
DC VAMC
Position
* must provide value
Postdoctoral Fellow
Predoctoral Student
Date of terminal degree
* must provide value
Today M-D-Y
Upload your diploma. If not able to at this time, please make sure you are ready to submit for the final application.
Type of degree(s)
* must provide value
Date of candidacy/date when you passed qualifying exams
* must provide value
Today M-D-Y
Upload Letter of Confirmation
* must provide value
Date of your anticipated date of graduation.
* must provide value
Today M-D-Y
Name of Graduate Studies Program/Department
* must provide value
Name of Graduate Studies Director
* must provide value
Email of Graduate Studies Director
* must provide value
Phone Number of Graduate Studies Director
* must provide value
List all stipend, salary, and/or research support (Do not include mentor's grants)
* must provide value
Past
Current
Pending
None
Check all that apply
Past Support
* must provide value
Current Support
* must provide value
Pending Support
* must provide value
Ethnicity
* must provide value
Hispanic or Latino Non-Hispanic Intentionally Withheld
Race
* must provide value
American Indian or Alaskan Native Asian Black or African-American Native Hawaiian or Pacific Islander White More than One Race Intentionally Withheld
Person with disability
Person from disadvantaged background
New investigator
Female
Check all that apply
Title of Proposed Research Project
* must provide value
First Name
* must provide value
Last Name
* must provide value
Academic Title (include Department and Institution)
* must provide value
Email Address
* must provide value
Phone Number
* must provide value
eRA Commons Username
* must provide value
Yes Unknown
eRA Commons username
* must provide value
List all current and pending research support for as required in NIH biosketch instructions
* must provide value
Current
Pending
Check all that apply
Current Support
* must provide value
Pending Support
* must provide value
First Name
* must provide value
Last Name
* must provide value
Academic Title (include Department and Institution)
* must provide value
Email Address
* must provide value
Phone Number
* must provide value
eRA Commons Username
* must provide value
Yes Unknown
eRA Commons Username
* must provide value
List all current and pending research support for as required in NIH biosketch instructions
* must provide value
Current
Pending
Check all that apply
Current Support
* must provide value
Pending Support
* must provide value
Do you have another co-mentor?
* must provide value
Yes
No
First Name
* must provide value
Last Name
* must provide value
Academic Title (include Department and Institution)
* must provide value
Email Address
* must provide value
Phone Number
* must provide value
eRA Commons Username
* must provide value
Yes Unknown
eRA Commons Username
* must provide value
List all current and pending research support for as required in NIH biosketch instructions
* must provide value
Current
Pending
Check all that apply
Current Support
* must provide value
Pending Support
* must provide value
Do you have a third co-mentor?
* must provide value
Yes
No
First Name
* must provide value
Last Name
* must provide value
Academic Title (include Department and Institution)
* must provide value
Email Address
* must provide value
Phone Number
* must provide value
eRA Commons Username
* must provide value
Yes Unknown
eRA Commons Username
* must provide value
List all current and pending research support for as required in NIH biosketch instructions
* must provide value
Current
Pending
Check all that apply
Current Support
* must provide value
Pending Support
* must provide value
Do you have a fourth co-mentor?
* must provide value
Yes
No
First Name
* must provide value
Last Name
* must provide value
Academic Title (include Department and Institution)
* must provide value
Email Address
* must provide value
Phone Number
* must provide value
eRA Commons Username
* must provide value
Yes Unknown
eRA Commons Username
* must provide value
List all current and pending research support for as required in NIH biosketch instructions
* must provide value
Current
Pending
Check all that apply
Current Support
* must provide value
Pending Support
* must provide value
Submit
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