send the completed form to: notification of mailing ... · dsrs/sab/dpm building 31, room b3c33....

National Institutes of Health Alumni Mailing Address System Notification of Mailing Address For Non-Employee Workers Send the completed form to: DSRS/SAB/DPM Building 31, Room B3C33 Section 1: Worker Information 1. Last Name First Name M.I. 2. Social Security No. - - 3. Sex M F 4. Date of Birth - - 4. Street Address (Use only leters and numbers. Do not use punctuation marks. Leave one space between words.) 5. City (Leave one space between words.) 6. State 7. Country (If not USA) 8. Zipcode - Section 2: NIH Program Information 1. Program Code See list below for codes. 2. Date joined program - - 3. Position Title 4. Administrative Code 5. Educational level code See list below for codes. Section 3: Certification Signature Date Program Codes Code Definition 01 Clinical Electives Program (MD and DDS students) 02 Clinical Center Volunteers 03 Contractor Personnel 04 FIC International Research Fellowships 05 Fogarty International Scholars GUEST RESEARCHERS: 06 Howard Hughes Medical Institute-NIH Research Scholars 07 National Research Council-NIH Research Associates 08 NIH Scientist Emeritus Program 09 NIH Health Scientist Emeritus Program 10 All other guest researchers 11 Health Care Volunteers (under authority 42 U.S.C. 217(b) (Clinical Center only)) 12 IRTA Predoctoral Fellows 13 IRTA Postdoctoral Fellows 14 IRTA Summer Fellows 15 National Research Service Award Intramural Fellows 16 NCI Cancer Prevention Fellowship Program 17 NCI Nurse Training 18 NCI Student Research Program 19 NCI Biotechnology Training Program 20 NCI Epidemiology and Biostatistics Training Program 21 Sobel Student Fellows SPECIAL VOLUNTEERS : (Sections 402 and 405 PHS Act) 22 FAES-administered fellowship or stipend support programs 23 Jesse Roth Foundation Fellows 24 All other special volunteers 25 Student Volunteers (under 5 U.S.C. 3133) 26 Visiting Fellows Highest Education Level Codes Code Definition 00 Not applicable Some elementary school-did not complete 01 02 Elementary school completed-no high school 03 Some high school-did not graduate 05 Terminal occupational program-did not complete 06 Terminal occupational program-certificate completion, diploma, or equivalent 07 Some college, less than one year 08 1 year of college 09 2 years of college 10 Associate degree 11 3 years of college 12 4 years of college 13 Bachelor's degree 14 Post-bachelor's 15 First professional 16 Post-first professional 17 Master's degree 18 Post-master's 19 Sixth-year degree 20 Post-sixth year 21 Doctorate degree 22 Post-doctorate NIH 2685-1 (06/13)

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Page 1: Send the completed form to: Notification of Mailing ... · DSRS/SAB/DPM Building 31, Room B3C33. Section 1: Worker Information 1. Last Name First Name. M.I. 2. Social Security No.--3

National Institutes of Health Alumni Mailing Address System

Notification of Mailing Address For Non-Employee Workers

Send the completed form to: DSRS/SAB/DPM Building 31, Room B3C33

Section 1: Worker Information1. Last Name First Name M.I.

2. Social Security No.

- -

3. Sex

M F

4. Date of Birth

- -4. Street Address (Use only leters and numbers. Do not use punctuation marks. Leave one space between words.)

5. City (Leave one space between words.) 6. State

7. Country (If not USA) 8. Zipcode

-Section 2: NIH Program Information1. Program Code

See list below for codes.

2. Date joined program

- -

3. Position Title

4. Administrative Code 5. Educational level codeSee list below for codes.

Section 3: CertificationSignature Date

Program CodesCode Definition01 Clinical Electives Program (MD and DDS students)02 Clinical Center Volunteers03 Contractor Personnel04 FIC International Research Fellowships05 Fogarty International Scholars

GUEST RESEARCHERS:06 Howard Hughes Medical Institute-NIH Research Scholars07 National Research Council-NIH Research Associates08 NIH Scientist Emeritus Program09 NIH Health Scientist Emeritus Program10 All other guest researchers

11 Health Care Volunteers (under authority 42 U.S.C. 217(b) (Clinical Center only))

12 IRTA Predoctoral Fellows13 IRTA Postdoctoral Fellows14 IRTA Summer Fellows15 National Research Service Award Intramural Fellows16 NCI Cancer Prevention Fellowship Program17 NCI Nurse Training18 NCI Student Research Program19 NCI Biotechnology Training Program20 NCI Epidemiology and Biostatistics Training Program21 Sobel Student Fellows

SPECIAL VOLUNTEERS : (Sections 402 and 405 PHS Act)22 FAES-administered fellowship or stipend support programs23 Jesse Roth Foundation Fellows24 All other special volunteers

25 Student Volunteers (under 5 U.S.C. 3133)26 Visiting Fellows

Highest Education Level CodesCode Definition00 Not applicable

Some elementary school-did not complete0102 Elementary school completed-no high school03 Some high school-did not graduate05 Terminal occupational program-did not complete06 Terminal occupational program-certificate

completion, diploma, or equivalent07 Some college, less than one year08 1 year of college09 2 years of college10 Associate degree11 3 years of college12 4 years of college13 Bachelor's degree14 Post-bachelor's15 First professional16 Post-first professional17 Master's degree18 Post-master's19 Sixth-year degree20 Post-sixth year21 Doctorate degree22 Post-doctorate

NIH 2685-1 (06/13)

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