Membership Application
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Welcome

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 faculty members engaged in or interested in pursuing cancer research.

Please complete the following online application to be considered for membership in the Cancer Institute.

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 four weeks. To learn more about Membership in the Cancer Institute, please click here. If you have any questions, please contact Nia Indelicato at NLIndelicato@uams.edu.

Campus

On which campus are you located?

Institutional ID

Please enter your institutional ID if you have one.

ID TypeID ValueManage
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First Name
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Please enter your first name.

Middle Name

Please enter your middle name.

Last Name
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Please enter your last name.

Published Names
You must answer this question in order to submit the form.

Please provide all of the names you have published under.

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Degrees
You must answer this question in order to submit the form.

Please select all degrees you currently hold.

Academic Title
You must answer this question in order to submit the form.

Please enter your academic title as given by your parent institution (eg. Assistant Research Professor).

Department
You must answer this question in order to submit the form.

Please enter the name of your home department.

Division

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

Email
You must answer this question in order to submit the form.

Please enter your institutional email address.

Applicant Type

Are you applying for membership as a graduate student, postdoc or fellow?

Nomination Letter
You must answer this question in order to submit the form.

Please upload a nomination letter in PDF format from a faculty member who is a current active CI member that is familiar with your cancer-related research. This letter will be reviewed along with your application.

Program Details
Research Program

Please select your primary research program of interest.

Research Program (Second Choice)

Please select your secondary research program of interest.

Current Pending Submissions

Do you currently have pending submissions for support of your cancer related research?

Pending Project Title, Funding Agency and Date of Submission
You must answer this question in order to submit the form.

Please list current pending submission(s) project title, funding agency and date of submission for each pending submission.

MyBibliography URL

Please provide a URL linking to your complete and current publication list (eg. My Bibliography on NCBI).

Applicant CV
You must answer this question in order to submit the form.

Please upload a current CV in PDF format.

Research Interest - Disease Site
You must answer this question in order to submit the form.

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

Research Interest(s) - Type of Research
You must answer this question in order to submit the form.

Please identify your cancer research area of interest(s) as defined by type of research. Select one or more responses that best matches your area of interest(s).

Research Interest - Topical Area
You must answer this question in order to submit the form.

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

Research Keywords

Please enter one or more keywords that describe your research in more detail.

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Research Interest Statement
You must answer this question in order to submit the form.

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
You must answer this question in order to submit the form.

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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