Form (Membership Application)
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Welcome Message

The Winthrop P. Rockefeller Cancer Institute brings together a wide-range of investigators with the common goal to prevent, cure, or better understand cancer to the benefit of all Arkansans. The Cancer Institute provides an infrastructure designed to nurture collaborations and ensure successful execution of high quality cancer research, especially peer-reviewed cancer-related research and investigator-initiated clinical trials. Membership in the Cancer Institute is open to all faculty members of UAMS engaged in or interested in pursuing cancer research.

Please complete the following online application to be considered for membership in the Cancer Institute. The application will take 10-15 minutes to complete, and you will need the following information to answer all questions:


  • The number of peer-reviewed cancer-related manuscripts you have published in the last two years.
  • A URL linking to your complete and current publication list (this is optional, but very useful for individuals with common names.)
  • Your current CV in Word or PDF format.

Once your online application is submitted, it will be reviewed by research program leaders, the Cancer Institute Membership Committee and the Cancer Institute Executive Director. You will be notified of your membership status via email within eight weeks. To learn more about Membership in the Cancer Institute, please click here. If you have any questions, please contact H Lee Smith at hsmith@uams.edu.

Campus

On which campus are you located?

Institutional ID
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Please enter your Institutional ID (if you have one)
OptionID ValueManage
First Name
(field is required)
Please enter your first name.
Middle Name
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Please enter your middle name.
Last Name
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Please enter your last name.
Applicant's Alt Names
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Please enter any variations on your name that you might expect to see in Pubmed or NIH Reporter.
First NameMiddle NameLast NameManage
Degrees
(field is required)
Please select all degrees you currently hold.
Academic Title
(field is required)
Please enter your academic title as given by your parent institution.
Department
(field is required)

Please enter the name of your home department.

Division
(field is required)

Please enter the name of your home Division (if you have one).

Email
(field is required)
Please enter your institutional email address.
Program Details
Research Program
Please select your primary research program of interest.
Research Program (Second Choice)
Please select your secondary research program of interest.
Reasons
(field is required)
Please briefly describe your reason(s) for wanting to be a member of the Cancer Institute.
Shared Resources
(field is required)
Please select all of the Cancer Institute Shared Resource(s) you expect to use.
CCTRA
Do you use the Cancer Clinical Trials and Regulatory Affairs (CCTRA) office?
Currently Submitting
Are you currently in the process of submitting an application for support of your cancer related research?
Proposed Funding Agency
(field is required)
What is the funding agency that would support the proposed research?
Application Deadline
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When is the application deadline?
Other Personnel
(field is required)
In addition to yourself, who are the other key personnel listed on the grant application, and what roles do they serve in the research project?
Personnel NameRoleManage
Clinical Trial PI
Are you currently a PI, Co-I or Co-PI on an Investigator-initiated clinical trial or have you been within the last 2 years?
Clinical Trial Funding
(field is required)
Please select all of the funding sources that are supporting your clinical trial. Comments should further specify the funding source, if appropriate (eg. for an NCI trial, you might enter “SWOG” into the comment box; for an industry trial, you might enter “Genentech” in the comment box)
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MyBibliography URL
(field is required)
You may provide a URL linking to your complete and current publication list (eg. My Bibliography on NCBI).
Collaborative Research
(field is required)

Briefly describe your collaborative cancer-related research that would fit within your research program of interest.

Collaborative Research (Inter Programmatic)
(field is required)
Briefly describe your collaborative cancer-related research that would fit within the other research programs or cross boundaries between research programs.
Applicant CV
(field is required)
Please upload your current CV in PDF or Microsoft Word format.
Other Support Document
(field is required)

Please upload a document showing your current other grant support. You can find a template, instructions and sample of this document at this link. If you do not have any current grant support, please create a document in the NIH other support format and state "None"

Research Interest - Disease Site
(field is required)

Please identify your cancer research area of interest as defined by disease site. Select all that apply.

Research Interest - Type of Research

Please identify your cancer research area of interest as defined by type of research. Select the one response that best matches your area of interest.

Research Interest - Topical Area
(field is required)

Please identify your cancer research area of interest as defined by type of topical focus. Select all that apply.

Research Interest Narrative
(field is required)

Please provide a brief paragraph describing your cancer research projects and interests. This content will be used to evaluate your application. If you become a member, this content may also be used on the Cancer Institute website or in Cancer Institute communications about research ongoing in the Cancer Institute.

Agreement
(field is required)
Membership in the Cancer Institute is reviewed at the time of application and annually thereafter. While some data that is required for this annual review can be generated from our campus data systems, we will be requesting some information directly from you on occasion. Data that we collect and review on a regular basis includes your UAMS appointment, cancer related grant activity, clinical trial activity, publications, and shared resource usage. We do not collect or track salary data. Acceptance of membership in the Cancer Institute indicates your willingness to allow us to access this information from campus systems on your behalf and your commitment to respond in a timely manner to direct requests for information from Cancer Institute Administration.

*By initialing and clicking submit, I confirm that I have reviewed the Winthrop P. Rockefeller Cancer Institute Membership Policy and agree to follow the guidelines set forth in this policy.
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