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Undergraduate Scholarship Program

OMB No. 0925-0299
Expiration Date 03/31/2014
Respondent Burden

Program Application
Instructions: Before you begin, you may want to review some helpful hints on using this electronic form and our privacy statement.

Eligibility Criteria:
  1. Candidates must be U.S. citizens or U.S. permanent residents.
  2. Candidates must be enrolled or accepted for enrollment as a full-time student at an accredited 4-year undergraduate institution located in the United States of America.
  3. Candidates must have an Undergraduate University Grade Point Average of 3.3 or higher on a 4.0-point scale or within the top 5 percent of your class.
  4. Candidates must have an 'Exceptional Financial Need' as certified by your undergraduate institution financial aid office (Federal Register, Vol. 77, No. 74, Tuesday, April 17, 2012).
Application Tips:
This form allows you to save a partially completed application. To take advantage of this feature:
  • Enter as much information into the form as you would like. Note that you must complete certain fields--Name, E-mail Address, Phone, etc. --in order to save a partial application.
  • Press "Save Partial Application & Quit" to save the information you have entered thus far. You will have to return later to complete your application.
  • When you first submit your partial application, you will receive an e-mail message containing instructions for accessing the online tool that allows you to review, modify, and complete your application.
Only completed applications are available for review by NIH investigators and administrators; partial applications are not accessible by NIH investigators. Once you complete your application, press "Preview Completed Application." You will be taken to a page displaying the information you have provided. To submit your completed application, you must select the "Save" button on the Preview page.

IMPORTANT NOTE: The deadline for receipt of completed applications is March 1, 2013 (11:59 p.m., Eastern Standard Time). Applications that are incomplete after the March 1 deadline will not receive further consideration.

  1. Please read the "Undergraduate Scholarship Program page" and ""UGSP Frequently Asked Questions" before beginning your online application.
  2. Be sure that the e-mail addresses you provide for your references are accurate. Incorrect e-mail addresses will delay the processing of your application and could result in your application's not receiving full consideration.
  3. Please note that this form accepts plain text inputs only. This means that special characters and formatting such as bullets, "smart quotes," bold or italic fonts, Greek letters, etc., will be lost or altered. To ensure your data appear as you intend, compose your inputs to the longer fields on this form using a plain text editor (e.g., Notepad for PC users or TextEdit for Mac users). In place of special formatting, you will need to rely on the use of capital letters, white space, asterisks, and other standard keyboard characters.
  4. Proofread your application thoroughly for accuracy and completeness; false or inaccurate information may be grounds for denying your candidacy or removing you from the program.
  5. Complete your application as early as possible and ensure that your references submit their letters promptly using our online system.
  6. Letters of recommendation are due no later than March 15, 2013, at 11:30 pm EDT. We will not accept letters after that time.
Required Field Indicates a required field.    Help Field Indicates a help button.
1. Minimally Required
You must enter this information if you wish to save your application.
Name:



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Enrollment: Are you enrolled in, or have you applied to, a 4-year college/university program located in the U.S.?
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Certification of Non-Delinquent Status: The Federal Debt Collection Procedures Act of 1990 precludes a debtor who has a Federal judgment lien against his/her property arising from a Federal debt from receiving Federal funds until the judgment is paid in full or otherwise satisfied. Applicants of the NIH Undergraduate Scholarship Program must certify that they do not have a judgment lien against their property arising from a debt to the United States.

I certify I do not have delinquent status.
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Certification of Application - Information is True, Complete, and Accurate: I certify that information given in this application (including any personal statements) is true, complete, and accurate to the best of my knowledge and does not omit any material fact, which would render the statement false, fictitious, or fraudulent as a result of the omission. I understand that the information given may be investigated and that any false representation is sufficient cause for rejection of this application, or, if awarded scholarship benefits, that I am liable for return of all awarded funds and, further, that any false statement may be punishable as a felony under U.S. Code, Title 18, Section 1001. I am aware that any false, fraudulent, or fictitious statement may, in addition to other remedies available to the Government, subject me to civil penalties under the Program Fraud Civil Remedies Act of 1986.
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Certification of Application - Release of Information to UGSP: To ensure your eligibility requirements, the UGSP may need to contact your academic institutions for clarification of information in your application or financial form.

I authorize the program(s) indicated in my Educational History to release information about my academic, financial, service, and any other pertinent information to administrators of the NIH Undergraduate Scholarship Program (UGSP) and to other authorized Government officials. This release is valid for six months after completion of all UGSP requirements.
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2. Personal Information
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(Use DC for District of Columbia and NA if your permanent address is not in the U.S.)
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3. Academic Information
Do you have coursework from a 2-year academic institution?
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Are you, or do you anticipate, transferring from a 2-year program to a 4-year program in Fall 2013?
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4. CV/Resume Sections
Copy and paste a plain text version of your curriculum vitae or resume into the sections below. Some reformatting may be necessary.
(Up to 9000 characters)
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5. References

Under the Family Educational Rights and Privacy Act of 1974, as amended (P.L. 93-380), you have the right to access the information contained within a letter of recommendation unless you have waived such access. The National Institutes of Health (NIH) does not require you to waive your permission as a condition of admission. For each reference, your response about waiving access to each letter of recommendation is required. Your references will be given your response in the recommendation request message sent by email. See Family Educational Rights & Privacy Act.

Once you submit your completed application, an e-mail request for a letter of recommendation will automatically be sent to each of the following individuals:
Reference 1:
Name:


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 Required Field Format: user@server.com
Waive Access:  Required Field
Reference 2:
Name:


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Waive Access:  Required Field
Reference 3:
Name:


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 Required Field Format: user@server.com
Waive Access:  Required Field
 How did you hear about this program? (Please select all that apply.)
Notice to all applicants:
It is your responsibility to ensure that all of the above information is correct. False or inaccurate information contained in this application may be grounds for denying your candidacy or removing you from the program.