Department of Surgery and Perioperative Care Research Affiliate & Visiting Scholar Interest Form

Department of Surgery and Perioperative Care

Research Affiliate & Visiting Scholar Interest Form

Last Name*

First Name*

Interest Form Submission Date*

Email Address*

Status*

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If other, please specify academic status below

Institution*

Where are you currently a student? If you are not currently a student, please provide the institution from which you most recently graduated.

UT EID

Volunteer*

Please confirm if you are interested in a volunteer research opportunity (unpaid).

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Visa Sponsorship*

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Preferred Work Location (Local vs Remote)*

Are you planning to be in Austin for some amount of time, or are you only looking to get involved remotely?

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Requested Start Date*

Requested End Date*

Anticipated Time Commitment*

Approximately how many hours per week will you be able to spend on this research?

Are you fluent in any languages other than English?*

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Please list any languages you are able to speak fluently.

Attach CV/Resume*

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Notes

Please add any additional notes about your availability, specific interests or skills, etc.

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