MSSU Scientists Application Form

MSSU Scientific Membership

Scientists Application Form

There are two categories of scientific membership: Associate Scientist (University) and Affiliate Scientist (non-University).
Successful applicants will be offered the Associate Scientist or Affiliate Scientist designation based on which eligibility criteria they meet.

Applications are typically processed within 7-10 business days.

If you require assistance or have any questions, please contact Claire Keenan.

Name

First Last

Pronouns

University or Institution Name

Mailing Address (University or Institution)

Street Address Address Line 2 City Province Postal Code

Office Phone

Main Position (Title/Institution)

Cross-Appointments (Title, Institution)

Academic Degrees

Areas of Research

Current Partnerships with Community Organizations

Have you received any formal training in patient-oriented research? Please list:

How do you demonstrate your commitment to supporting and/or conducting patient-oriented research?

Current CV including list of publications, grants, and other evidence of patient-oriented research activity for the last five years.

Drop files here or

Max. file size: 50 MB.

Profile Picture (JPG, JPEG, PNG)

Max. file size: 50 MB.

Date

This form was modified from the Beatrice Hunter Cancer Research Institute.