1. INSTRUCTIONS

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100% of survey complete.

Dear Graduate Applicant,

This form initiates your application for a RISE to the Postdoctorate Graduate Scholar award. It is recommended that you have your transcripts and resume at hand when you complete this form.

Please leave nothing blank. Fill in all cells with either text, a number or n/a for not applicable.

Once you submit the form, send a follow up email to rise@nmsu.edu. A member of the program staff will contact you to provide you with information about the second part of the application.

***Please note, as per NIH policy, RISE can only support students who are a U.S. citizen, a non-citizen national, or a permanent resident. Award offers are contingent on submission of official documents proving you meet this NIH eligibility requirement. In additions, as per NMSU policies, a background check may be required. All offers of employment are contingent upon the availability of funds.***

Thank you for interest in RISE as a mechanism to further your professional aspirations,

Best wishes,

The RISE Program Directors :
Shelley Lusetti
Elba Serrano
Graciela Unguez

* 1. YOUR APPLICATION MATERIALS WILL COMPRISE PART OF YOUR OFFICIAL FILE. APPLICATIONS MAY BE REVIEWED FOR PROGRAMMATIC PURPOSES BY THE REVIEW COMMITTEE, PROGRAM STAFF AND EVALUATORS

* 2. NAME

* 3. RISE Program Goals established by the Funding Agency:
RISE to the Postdoctorate is supported by a grant from NIH and is tasked with the following goals by the federal agency (NIH PAR-10-004):
• “The goal of the RISE Program is to increase the number of students from UR groups in biomedical and behavioral research who successfully complete the Ph.D. degree in these fields.”
• “For the purpose of the RISE Program UR groups include those reported by the National Science Foundation (NSF) as well as the National Academies to be nationally underrepresented in biomedical and behavioral sciences (i.e., African Americans, Hispanic Americans, American Indians, and Natives of US Pacific Islands, and people with disabilities).“

* 4. Please confirm you have read and understand the following financial eligibility requirements established by NIH for TWD RISE.

"To receive salary support from the RISE program, students must be U.S. citizens or non-citizen nationals or permanent residents and must be enrolled full time in academic degree programs in biomedical or behavioral science fields at the applicant institution. (A non-citizen national is a person who, although not a citizen of the United States, owes permanent allegiance to the U.S. This is generally a person born in a land that is not a state, but that is under U.S. sovereignty, jurisdiction, or administration -- for example, American Samoa.) An individual lawfully admitted for permanent residence must possess a currently valid Permanent Resident Card (USCIS Form I-551) or other legal verification of such status prior to appointment on the grant. Individuals on temporary visas, those seeking asylum, or refugees are not eligible for support from the RISE program."
http://grants.nih.gov/grants/guide/pa-files/PAR-10-004.html


  Yes I understand No I do not understand
a1) Individuals on temporary visas, those seeking asylum, or refugees are not eligible for support from the RISE program
a2) I must be able to provide documentation that I am a US citizen, resident or non-citizen national (social security cards and driver's license are not acceptable documents for this purpose)
b) I will undergo a background check
c) I must enroll in the NIH federal training database (X-train) and be approved by the NIH.
d) As part of the NIH appointment process I must provide a "Statement of Nondelinquency on Federal Debt".
e) My support is contingent on availability of external funds

* 5. RISE Program Goals

RISE is a highly demanding training program requires regular participation in many Program activities throughout the academic year and summer. Students are expected to reside on the NMSU campus during the academic year.

* 6. Contact info (enter n/a if not applicable)

* 7. current RISe graduate student?

Please note, students who are awarded RISE-MS support will not be eligible for support for RISE-PhD .

* 8. former RISe graduate student seeking readmission?

Please note, students who are awarded RISE-MS support will not be eligible for support for RISE-PhD .

* 9. I am applying for the following support:

Please note, students who are awarded RISE-MS support will not be eligible for support for RISE-PhD .

* 10. I am applying for support for::


  2017
Spring
Summer
Fall

* 11. NMSU graduate status (select all that apply)

* 12. What is your College affiliation?

* 13. NMSU degree goals. If you seek advice, so state

* 14. FACULTY ADVISOR -

* 15. Briefly summarize your research interests and postgraduation goals. maximum 150 words

* 16. Undergraduate education

* 17. Graduate education (enter n/a if not applicable)

* 18. If you have taken the GRE, please provide your scores here. enter n/a if not taken

* 19. Degrees (select all that apply)

* 20. If applicable, in what year did you receive the following? Be sure to select one item from the responses in each row including N/A

  20th century 2000-2005 2006 2007 2008 2009 2015 2010 2011 2012 2013 2014 not applicable
HS/GED
BA/BS (most recent)
MA/MA (most recent)
PhD or other doctorate (most recent)

* 21. RISE to the Postdoctorate Scholars are required to participate in a PROGRAM structured series of training workshops, seminars and courses that take place usually between 7 am and 6 pm Mon-Fri on the NMSU main campus. Please indicate your willingness and ability to participate in program training activities.

* 22. RISE to the Postdoctorate Scholars are required to participate in a research internship at a partner institution, usually during the summer. Please indicate your willingness and ability to participate in a summer internship.

* 23. RISE students must dedicate 20 hrs/week to dissertation research, professional training and program activities. The RISE award does not support students to attend classes nor to participate in clinical training experiences. Students who cannot devote 20 hrs/week to research and training in addition to fulfilling coursework and other duties can request a minimum of 10 hrs/wk of salary support. Hours dedicated to research and dissertation credit (550, 598, 600, 698, 700 etc) also do not count toward the 20 hours/week of RA support.

* 24. Counting the current semester, how many semesters have you been enrolled at NMSU in a graduate program?

* 25. When do you expect to complete your PhD degree?

  N/A 2014 2015 2016 2017 2018 2019>>
spring
summer
fall

* 26. When do you expect to complete your MS degree? Select only one answer

  N/A 2014 2015 2016 2017 2018 2019>>
spring
summer
fall

* 27. What is the status of your exams?

  N/A completed pending: fall 2010 spring 2011 summer 2011 fall 2011 2012 2013 2014 2015 2016>>>
Qual
Comp
PhD defense

* 28. Please summarize your publications record

* 29. Please summarize your record of national conference presentations

* 30. Please list (with dates) what you consider your top 5 Academic Honors

* 31. Please summarize your coursework and informal training in responsible conduct in research and academic integrity (professional ethics)

* 32. Prior NIH MORE and NSF support

  at NMSU at another institution not applicable
I have received undergraduate RISE support
I have received undergraduate MARC support
I have received undergraduate BRIDGES support
I have received undergraduate AMP support
I have received Graduate RISE support
I have received Graduate AMP support
I have received Graduate BRIDGES support
I have received Graduate IGERT support
DEMOGRAPHICS.
We request this information because the RISE Program is required to report demographic data to NIH. Your assistance with providing part or all of this information is appreciated.

* 33. I am a first generation college graduate because neither of my parents had a college degree during the time I was enrolled as a student completing my undergraduate degree.

* 34. There has been a lapse of three years or more between my last degree and my pursuit of a PhD degree.

* 35. Please select all that apply:

  Yes No Prefer not to disclose
I am a US military veteran.
I am in the US National Guard.
I have experience in K-12 education
I volunteer with non-profit organizations in the community at least three times a semester
I participate in student governance at the department, college, or university level
I have received a Pell grant.
I grew up in a rural environment.
I grew up in an inner city environment.

* 36. What is your gender?

* 37. Communication: Please select all that apply

* 38. NIH objectives for diversity of RISE grants. Please select all with which you identify

* 39. Please list ethnicities with which you identify.

Enter N/A if you do not wish to disclose.

* 40. Please estimate the amount of time to complete this form

* 41. Enter

report completion date
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