DCI Diversity SupplementRegistration

DCI Diversity Supplement

Registration - Trainee Form

First Name*

Last Name*

Email address*

Name of your college/university*

Current or alma mater

Area of study/research

Short description of your research area

Current position*

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Please describe how participation in an NIH-diversity supplement will benefit your educational and career goals

For more information on what a diversity supplement is, click here. Please right click to open in a new tab so you don't lose your work.

Please select the research categories you are interested in*

You can select multiple categories

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Please select the primary research area you are interested in*

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Please select the secondary research area you are interested in*

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Please select the tertiary research area you are interested in

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Please describe your research interests

Please answer the prompt in a short paragraph (100-300 words)

Please select any prior research skills/experience

You can select multiple categories

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Please describe in more detail any prior research-related experience that required data collection and analysis. If any, please indicate the duration.

Please answer the prompt in a short paragraph (100-300 words)

Please upload your CV/Resume*

If you do not have one, please reference the following guides on making a resume or CV. Please right click to open in a new tab so you don't lose your work.

Drag and drop files here or

NIH guidelines state that trainees supported through diversity supplements much be US citizens or permanent residents. Are you eligible under this guideline?*

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What is your gender identity?*

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Do you consider yourself transgender?*

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Do you consider yourself part of the LGBTQ+ community?*

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Do you identify as any of the below groups? Please select all that apply.*

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Do you identify as:*

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Are you from a disadvantaged background?*

See here for the NIH definition. Please right click to open in a new tab so you don't lose your work.

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Are you the first generation in your family to be born and/or raised in the United States?*

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Are you the first generation in your family to attend college?*

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Do you have a disability?*

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If you have a disability and would like to share so accommodations can be made on your behalf, feel free to share below.

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