LIVESTRONG Cancer Institutes

LIVESTRONG Cancer Institutes

Application for Membership

Instructions

Before filling out this application, please read the LCI Membership Criteria. A completed application includes: 1. Membership Application Form; and 2. Current copy of applicant's NIH Biosketch in the latest NIH format (for Full or Associate Members); or 3. CV (for Affiliate Members) All complete applications will be reviewed by reviewed by appropriate Program Leaders and LCI's Governance Committee for final vote on approval. For questions, please contact Melissa Huddleston, Assistant Director of Administration at Livestrong Cancer Institutes: mhuddleston@austin.utexas.edu

Name*

Faculty Title/Rank*

Department*

Office Phone*

Fax

Email*

1. Research Program

Please indicate the LCI Program in which you think your research best fits (select all that apply):

Cancer Prevention and Control

Developmental Therapeutics

Molecular Oncology

Survivorship and Supportive Care

Tumor Immunology and Microenvironment

Quantitative Oncology

2. Briefly describe how your research relates to cancer. This statement should contain sufficient detail to allow reviewers to understand how you are involved in cancer research (i.e. basic, clinical or both), what types of cancer are impacted by your research or clinical activities, and whether the research has translational potential. In addition, your statement should provide the names of other cancer center members with whom you collaborate or intend to establish collaborations, and identify any shared resources that you intend to use in pursuit of your cancer research program.

3. Describe current or pending cancer-related research projects in which you participate. Include PI, funding source or organization, grant or contract number, project period, title and costs.

4. List any cancer-related committees or organizations of which you are a member.

5. List any cancer-related publications within the last three years (Full and Associate Members):

6. Describe how you actively participate in clinical, community, philanthropic, research or educational missions of the LCI (Affiliate Members):

7. Additional information to be considered with application:

Please upload your NIH Biosketch (Full or Associate Members) or CV (Affiliate Members)*

Drag and drop files here or

I have read the membership criteria of the LIVESTRONG Cancer Institutes and agree with the objectives and requirements stated therein.*

Send me a copy of my responses

Privacy Notice|Report Abuse