Pre-Application for BTNRH Postdoctoral Training Program Page ContentAn individual interested in learning more about postdoctoral training opportunities at BTNRH may submit this form to signify interest and to obtain more information about our program. Postdoctoral training may be applicable for an individual who will soon complete, or who has recently completed, a doctoral degree (Ph.D., D.Sc., M.D.-Ph.D.) in communication disorders and related fields. Major support for our training program comes from the National Institutes of Health (NIH) through an institutional postdoctoral T32 training grant in communication disorders and related fields. Other postdoctoral training positions may be available in these fields and auditory neuroscience through other support mechanisms. Your completion of this pre-application form will inform us of your interest in our training program, and provide us with contact information and other general background information. The form includes a comments field at the end in which you may submit specific questions to us regarding our program. Consistent with the guidelines of the NIH T32 grant, BTNRH has a recruitment and retention plan to enhance diversity in postdoctoral training. This plan extends to the following classes of candidates: individuals from racial and ethnic groups that are underrepresented in health-related sciences on a national basis, individuals with disabilities, and individuals from disadvantaged backgrounds. The pre-application form includes questions in this area that will help us identify such individuals. All information that you may provide will remain confidential at BTNRH, except for de-identified data that BTNRH may provide to the NIH at their request. To begin, please complete the form and select the "Submit" button at the bottom of the form. Your form will not be sent unless you click the submit button. We will respond promptly to your inquiry. Your Name* Telephone Number* Email Address * Mailing Address* Address Line 2 City* State* State AL - Alabama AK - Alaska AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida GA - Georgia HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MD - Maryland MA - Massachusetts MI - Michigan MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VT - Vermont VA - Virginia WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming Zip Code* Current Position* Doctoral-Granting Instituion in which you are enrolled or have a degree* If you have completed your doctoral degree, provide the year of graduation. Otherwise, provide the month and year in which you expect to graduate* (ex: 01/2017) Doctoral Degree Ph.D. D.Sc. M.D.-Ph.D Other Brief Description of your research field, or title of dissertation if graduated* Are you a citizen or noncitizen national of the United States, or have you already been lawfully admitted for permanent residence in the United States? (pertains to eligibility for a NIH Ruth L. Kirschstein National Research Service Award (NRSA) Short-Term Institutional Training Grant) Yes No Not Sure The following questions are relevant to enhancing the diversity of trainees from under-represented groups in post-doctoral training at BTNRH. Your responses to these questions are entirely voluntary. You may choose not to answer these or other questions. Your pre-application will be considered no matter how you choose to answer. We do seek this information because any responses are useful to us, and also to the NIH, in efforts to enhance the diversity pool of applications for postdoctoral fellowships. Please inform us if you are a member of one or more of the following racial or ethnic groups African American Hispanic American Native American Alaskan Native Hawaiian Native Natives of the U.S. Pacific Islands Please inform us if you have a disability, which is defined by the NIH as a physical or mental impairment that substantially limits one or more major life activities. Yes No Not Sure Please inform us if you are from a disadvantaged background. This includes individuals from a family with an annual income below established low-income thresholds, and from a social, cultural, or educational environment such as that found in certain rural or inner-city environments that inhibit the individual from obtaining knowledge, skills, and abilities necessary to develop and participate in a research career. Yes No Not Sure Please submit any additional comments or questions to use about postdoctoral training at BTNRH in the space below Thank you for your interest in the Boys Town National Research Hospital Research Center and our Post Doctoral Pre Application process. We will review your information and contact you as soon as possible. Thank you. We apologize, but an error has occured during processing of this form. Please try again later.