Appendix D
APPLICATION FOR RESEARCH ASSOCIATE PROGRAMS



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Appendix D APPLICATION FOR RESEARCH ASSOCIATE PROGRAMS OFFICE USE ONLY APPLICATION ID# THIS IS AN EXAMPLE-ONLY APPLICATION – DO NOT SIGN. DO NOT SUBMIT. Postdoctoral Senior Applicant Last or Family Name First Name Middle Name Maiden Name (if applicable) City Home or Institution, MailCode/Stop, Bldg./Room, Number/Street Zip (Postal) Code CURRENT Country Address State / Province City Home or Institution, MailCode/Stop, Bldg./Room, Number/Street Zip (Postal) Code PERMANENT Address State / Province Country Indicate ALL countries of which you are a citizen. Passport Expiration Date(s) CITIZENSHIP Date Month / Day / Year Number If you are a naturalized US citizen, enter your naturalization date and number. Visa Type and Category Date J-1 Status (DS-2019) Expires If you are a non-US citizen already in the US, enter the type of visa you hold. Alien Registration Number If you are a US legal permanent resident, enter your alien registration number and enclose a copy of your alien registration (green) card. EDUCATION – List in order, beginning with the most recent degree awarded or expected. Awarded or Complete Name of University or College Inclusive Dates Degree Discipline / Field Code Degree Expected including City, State/Province, Country Year to Year refer to Field Reference List Month / Year - - - - - - All transcripts for Postdoctoral applicants must be enclosed with the application package. HONORS AND AWARDS Complete Name of Institution Inclusive Dates Title including City, State/Province, Country Year to Year - - - Title of Research Proposal 114

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OFFICE USE ONLY APPLICATION Last Name ID continued Have you previously applied for a National Academies Associateship? Year NO YES (Agency or Agencies) Are you a former National Academies Research Associate? Tenure Dates Year to Year NO YES (Agency or Agencies) - EMPLOYMENT – Professional, Scientific, Administrative, etc. List in order, beginning with most recent. Title or Name of Organization Inclusive Dates Employment Sector Academic Rank including City, State/Province, Country Year to Year - - - - Will you be on official leave from your current position, to which you will return? NO YES PROGRAM INFORMATION – You may apply for a maximum of three (3) different Agencies. NASA Center Agency or Agencies Laboratory or Proposed Research Adviser Research Opportunity Number Field of Proposed Research. Code Field Name Code Proposed Length of Tenure (for Seniors only) Proposed Starting Date (Month / Day / Year) months REFERENCES – Professional, Scientific, Administrative, etc. Enter the names, titles, and professional addresses of four (4 ) respondents who are familiar with your research. For recent doctoral recipients, the first name listed should be that of the thesis adviser. Full Name of Respondent Complete Professional Mailing Address of Respondent 1) 2) 3) 4) extra 5) 115

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APPLICATION OFFICE USE ONLY continued ID# This information is used by the NRC and sponsors to process awards. Optional information on race and ethnicity is for statistical purposes. Information on this page is not seen by reviewers. Applicant Last or Family Name First Name Date of Birth Month / Day / Year Place of Birth City, State/Province, Country APPLICANT U.S. Social Security Number Sex Marital Status Race Ethnicity Male Female Single Married Office Phone Home Phone CONTACT Fax INFORMATION E-mail Spouse's Last or Family Name First Name SPOUSE Date of Birth Month / Day / Year Place of Birth City, State/Province, Country Date of Birth Place of Birth Dependent Full Name Month / Day / Year City, State/Province, Country OFFICE USE ONLY APPLICATION Last Name ID# continued To assist us in making information available to a greater number of potential applicants, it is important for us to learn how you initially heard about the National Academies Research Associateship Programs. Please check ONLY ONE of the following: colleague or fellow graduate student 116

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Ph.D. thesis adviser or other professor university placement office former or current NRC Research Associate Research Adviser or other scientific staff at the federal Laboratory Research Associateship Programs’ staff member at professional scientific meeting Title of Meeting Date of Meeting Month / Year Advertisement in professional publication Name of Publication Other Please Specify To which review are you applying? March Review (deadline February 1) June Review (deadline May 1) September Review (deadline August 1) January Review (deadline November 1) 117

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Research Associateship Programs PREVIOUS AND CURRENT RESEARCH OFFICE USE ONLY to be completed by Postdoctoral applicants only ID# Applicant Last or Family Name First Name Middle Name Maiden Name (if applicable) Date of Ph.D. Month/Year Complete Name of University or College Thesis Adviser / Title of Ph.D. Dissertation Status of Ph.D. Dissertation Published Accepted for publication In preparation for publication Not to be published Attach a concise description of all investigations, stating where, when, and with whom they were carried out. (Maximum of 1200 words, double-spaced, 12-point font. DO NOT SEND REPRINTS.) Attach a list of publications in the following order: 1) refereed journal articles; 2) books; 3) published proceedings; 4) non-refereed articles; and, 5) patents. Citations should include the following: a) authors; b) year of publication; c) title; d) full name of journal; e) volume number; and f) page number(s). (Maximum of 1800 words, double-spaced, 12-point font. DO NOT SEND REPRINTS.) 118

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Research Associateship Programs PREVIOUS AND CURRENT RESEARCH OFFICE USE ONLY to be completed by senior applicants only ID# Applicant Last or Family Name First Name Middle Name Maiden Name (if applicable) Attach a concise description of all investigations, stating where, when, and with whom they were carried out. (Maximum of 1200 words, double-spaced, 12-point font. DO NOT SEND REPRINTS.) Attach a list of publications within the past five (5) years in the following order: 1) refereed journal articles; 2) books; 3) published proceedings; 4) non-refereed articles; and, 5) patents. Citations should include the following: a) authors; b) year of publication; c) title; d) full name of journal; e) volume number; and f) page number(s). (Maximum of 1800 words, double-spaced, 12-point font. DO NOT SEND REPRINTS.) 119

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Research Associateship Programs OFFICE USE ONLY REFERENCE REPORT ID# APPLICANT: attach a brief abstract of your Research Proposal. If you are applying to more than one Agency with different Research Proposals, please submit separate abstracts, and identify the Agency to which each refers. Maximum of 350 words per abstract. Applicant Last or Family Name First Name Field of Proposed Research Agency or Agencies Laboratory or NASA Center Title of Research Proposal RESPONDENT: return the Reference to the applicant -- completed, signed, in a sealed envelope with respondent's signature across the envelope flap. Full Name & Title of Respondent Institutional Affiliation Address Office Phone E-mail 1) I have known this applicant in the following capacities (you may check more than one) as an undergraduate as a graduate student as a teaching/research assistant as my thesis advisee as a professional colleague by reputation only 2) I was acquainted with the professional work of this applicant from Month / Year to Month / Year 3) I had a opportunity to observe the quality of this applicant’s work. poor fair good excellent 4) If the applicant is/was a student, how does he/she compare with students currently in your department? Lower half Upper half Top 25% Top 10% Top 1% 5) Please indicate on this scale, your overall impression of this applicant. (Check ONLY one.) Below Average Above Agerage Excellent Outstanding Inadequate Opportunity to Observe Average OFFICE USE ONLY REFERENCE REPORT ID# continued Applicant Last or Family Name First Name 6) Please comment on the Applicant’s scientific and technical abilities, both in comparison with other scientists and engineers with similar training and experience and with respect to the proposed research (see attached Abstract). Include in your assessment the following: a) knowledge of the field; b) skill in experimental design; c) technical abilities; d) innovative abilities; e) ability to work independently; f) analytical abilities; and, g) skills in interpreting and reporting research. 120

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OFFICE USE ONLY REFERENCE REPORT ID# continued Applicant Last or Family Name First Name RESPONDENT: Your response below is necessary if applicant requests information from the file. I ask that the National Academies maintain the confidentiality of my identity to the extent permitted by law. I further ask the National Academies to maintain the confidentiality of these comments to the extent permitted by law. I ask that the National Academies maintain the confidentiality of my identity to the extent permitted by law. I do not ask the National Academies to hold my comments in confidence. My preparation of this Reference Report is not conditioned on the request that the National Academies hold my identity or comments in confidence. Signature of Respondent Date Please also print your name Respondent for a Senior Applicant may write a Letter of Reference instead of completing the Reference Report form, but should also address the points listed on this form. The Reference Report or Letter of Reference must be in English, must have a current date, and IF sending a hard copy, must bear the original signature (not photocopy, fax, or electronic) of the respondent who is listed on the Application. Respondent may return the Reference Report or Letter of Reference to the applicant -- completed, signed, and in a sealed envelope with the respondent's signature clearly written across the envelope flap. OR Respondent may send the completed Reference Report or Letter of Reference directly to the Associateship Programs office (rap@nas.edu) as an e-mail attachment. It must come directly from the Respondent so we can accept the name on the ‘From’ line as the official signature. 121

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Research Associateship Programs OFFICE USE ONLY RESEARCH PROPOSAL ID# Applicant Last or Family Name First Name Middle Name Maiden Name (if applicable) PROPOSED RESEARCH ADVISER INFORMATION NASA Center Proposed Research Adviser Agency or Agencies Laboratory or 1) 2) 3) Title of Research Proposal ATTACH DETAILED RESEARCH PROPOSAL (Maximum of 3000 words, double-spaced, 12-point font) The Research Proposal should be sufficiently complete for outside peer review purposes. Description of the proposed research must include the following: a) statement of problem; b) background and relevance to previous work; c) general methodology and procedure to be followed; d) explanation of new or unusual techniques; e) expected results and their significance and application; and, f) literature citations where appropriate. 122

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APPENDIX OFFICE USE ONLY Research Proposal ID# Applicant Last or Family Name First Name ANTICIPATED RESEARCH NEEDS -- Indicate special requirements necessary to conduct your research. (Entering information electronically expands the field to accommodate all of the space you need.) 1) Describe activities related to the acquisition or collection of data, such as field activities, research voyages, or observatory use 2) Computer resources 3) Specialized equipment 4) Other 123

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Research Associateship Programs OFFICE USE ONLY LABORATORY/CENTER REVIEW ID# THE PROPOSED RESEARCH ADVISER COMPLETES THIS SECTION. Applicant Last or Family Name First Name Middle Name Maiden Name (if applicable) Agency or Agencies Laboratory or NASA Center Research Opportunity Number Title of Research Proposal Proposed Length of Tenure Proposed Starting Date Level for seniors only Month / Day / Year Postdoctoral Senior number of months PROPOSED RESEARCH ADVISER INFORMATION Adviser Name Adviser Office Phone Adviser E-mail Adviser Address City State Zip (Postal) Code Please address the overall scientific quality of the research proposed by this applicant, including the specific points indicated on the following page. Be sure the applicant’s name is at the top of each page. Recommended for review Not recommended for review – no Laboratory interest. Signature of Proposed Research Adviser Date Please also print your name After completing the above portion, sign, date and forward this form to the Laboratory or Center Program Representative. LABORATORY/CENTER PROGRAM REPRESENTATIVE’S RECOMMENDATION The Laboratory/Center recommends this Research Proposal for review. The Laboratory/Center does not recommend this Research Proposal for review. Laboratory/Center Program Representative’s Comments Signature of Laboratory/Center Program Representative Date Document should be sent by express delivery to: Research Associateship Programs The National Academies 2001 Wisconsin Avenue, NW [GR 322A] Washington, DC 20007 124

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LABORATORY/CENTER REVIEW OFFICE USE ONLY ID# Applicant Last or Family Name First Name 1) Are the proposed objectives realistic? 2) Does the proposal reflect innovative thinking? 3) Is the technical work plan sound, and does it incorporate state-of-the-art methods? 4) Can the research be accomplished in the proposed timeframe? Please also comment on the relevance of the proposed research to the mission of your agency. If specialized equipment or facilities are needed for the proposed research, please address the availability of these. If animal or human subjects will be used in the proposed research, indicate if an IACUC or IRB approval has been or will be obtained. 125