NIH Fellows Handbook

NIH Postdoctoral/Clinical/Research
Fellow Information Form

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The Office of Education and the NIH Fellows Committee are compiling a Fellows Directory. Copies will be available to all fellows and the addresses will be used for mailing issues of The Catalyst and other items of interest.

Please complete and return this form by fax to the Office of Education on (301) 402-8975.

 

Full Name (First/MI/Last):

NIH Institute, Lab/Branch, and Section:

NIH Address: Building: Room:

Birth Date (for identification, not publication):

NIH Phone:

NIH Fax:

NIH E-mail:

Are you a (check one):

Research Fellow
Clinical Fellow

Date you began at NIH:

Approx. date of completion:

Highest Degree (check):

M.D. M.D., Ph.D. Ph.D.
D.D.S. D.V.M. D.M.D.
D.O. Other (Specify):

Institution(s) and Years Degree(s) Awarded (i.e., Stanford [Ph.D.-1985]):

I am interested in the following major special interest groups (check one or more):

Cell Biology Clin. Research Genetics Immunology
Molecular Biology
Latino/Hispanic
       Directory		 Neurobiology Structural Biology

Please fax completed form to the Office of Education on (301) 402-8975.

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