Form Nih 2762-3 - Undergraduate Scholarship Program (Ugsp) - Academic Enrollment Certification And Service Obligation Deferment Request - U.s. Department Of Health And Human Services Page 2

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Last Updated – August 20, 2015
OMB No. 0925-0299
Form approved for use through 08/31/2016
Deferment Request Form – Reverse Side
A deferment is a period during which I have been approved to postpone my service obligation to the National Institutes of Health (NIH).
Deferment Eligibility Criteria:
I may defer (postpone) my service obligation while I am:
" Enrolled full-time in an accredited MEDICAL SCHOOL.
" Enrolled full-time in GRADUATE SCHOOL (doctoral-level programs only).
Scholars enrolled in an UNDERGRADUATE DEGREE PROGRAM, please note:
" Submission of this form certifies your continuing undergraduate enrollment. If you fail to submit this form, the Undergraduate
Scholarship Program (UGSP) will assume that you have withdrawn from your undergraduate degree program. Withdrawal from college
prior to graduation constitutes a breach of your contract with the NIH.
Authorized Certifying Official
" Registrar or authorized school official or designee.
Privacy Act Notice
The primary use of information collected via the Office of Intramural Training and Education (OITE) online forms is to evaluate an
applicant's qualifications for research training at the National Institutes of Health (NIH). Information may be used during admission
consideration; in preparing appointment paperwork; and to provide data for training program evaluation. Information will be disclosed
to investigators, members of advisory committees, OITE staff, and contractors working on our behalf. Additional disclosures may be
made to law enforcement agencies concerning violations of law or regulation. Application for this program is voluntary, however, in
order for the OITE to process an application, the applicant must complete the required fields.
The legal authority granted to NIH to train future biomedical scientists comes from several sources. Title 42 of the U.S. Code, Sections
241 and 282(b)(13) authorize the Director, NIH, to conduct and support research training for which fellowship support is not provided
under Part 487 of the Public Health Service (PHS) Act (i.e., National Research Service Awards), and that is not residency training of
physicians or other health professionals. Sections 405(b)(1)(C) of the PHS Act and 42 U.S.C. Sections 284(b)(1)(C)] and 285-287
grant this same authority to the Director of each of the Institutes/Centers at NIH.
NIH 2762-3

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