Institute for Health Disparities Artificial Intelligence Machine Learning Center Texas CEAL NCI MI-CCP Program Texas Conference on Health Disparities National Research Mentoring Network HSC Scholars in Cancer Research Programs & Training Faculty Grant Writing and Professional Development Graduate and Health Professional Student Training Programs Summer Undergraduate Research Internship Program (SRIP) K-12 Outreach About Coordinated Plan Institute for Health Disparities – In The News Meet the Team at The Institute for Health Disparities Mission and Vision Publications IHD Home HomeInstitute for Health DisparitiesInstitute for Health Disparities ProgramsGraduate and Health Professional Student Training ProgramsPromoting Diversity in Research Training for Health Professionals (PDRT)Promoting Diversity in Research Training (PDRT) Menu Artificial Intelligence Machine Learning Center Texas CEAL NCI MI-CCP Program Texas Conference on Health Disparities National Research Mentoring Network HSC Scholars in Cancer Research Programs & Training Faculty Grant Writing and Professional Development Graduate and Health Professional Student Training Programs Summer Undergraduate Research Internship Program (SRIP) K-12 Outreach About Coordinated Plan Institute for Health Disparities – In The News Meet the Team at The Institute for Health Disparities Mission and Vision Publications IHD Home Promoting Diversity in Research Training (PDRT) Promoting Diversity in Research Training (PDRT) Application Date MM slash DD slash YYYY Name* First Last Local Street Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Best way/time to reach me is: Permanent Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Permanent Phone*Name of relative who will know your address in the future: Address of relative who will know your address in the future: Gender* Male Female Health professional school currently attending* Current GPA* Cumulative Undergraduate Grade Point Average:* Are you participating in any biomedical and/or behavioral research currently?* Yes No If yes, please state the field:* Ethnic Background (Check one):* African American Alaskan Native Asian Hispanic Native American White Mulitracial Other Are you Hispanic (or Latino)* Yes No Intentionally Withheld Citizenship Status* U.S Citizen U.S. Permanent Resident Applying for U.S. Permanent Resident Military Status* Active Duty Veteran Reserve National Guard Non-Military Are you currently under charge or have you ever been convicted of a felony or misdemeanor, other than minor traffic violations:* Yes No Give a brief description of your interests in the health disparities and/or diversity areas.*Describe your career/professional goals:*Why do you feel that you should be selected as a PDRT Scholar?*Consent* By clicking the checkbox below I certify that all of the information provided to UNT Health Science Center is true and correct to the best of my knowledge. (This is your electronic signature)
Social media