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Resident Electives Program (REP) Application
OMB Number: 0925-0698
OMB Expiration Date: 10/31/2026
Public Reporting Burden Statement
Instructions: If you already have a saved an application click on the Login button
Before you begin, you may want to review a statement about
privacy
. After you fill out the application form below, press the [Save] button at the bottom of this page to resume your application later. You MUST Press the [Submit] button to complete the application process.
Applicants are advised to apply a minimum of three months prior to the start date of the elective in which they would like to participate.
Eligibility Requirements for the NIH Resident/Fellow Electives Program
All required fields are notated with an asterisk*.
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Contact Details
Title*:
Select
Dr.
Mr.
Ms.
First Name*:
Middle Initial:
Last Name*:
Degree*:
Select
D.O
M.D
M.D., Ph.D.
Email Address*:
Current Home Address*:
City:
State:
Select
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Not Applicable
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands, U.S.
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone Number*:
Current PGY Level*:
Select
PGY1
PGY2
PGY3
PGY4
PGY5
PGY6
PGY7
Status
Citizenship Status*:
Select
US Citizen
Permanent Resident
Foreign Citizen
Previous research experience at NIH:
Select
No
Yes