Membership Application

Please Complete the Following Sections to Request Membership:

To apply for membership to the Stanford Medicine Children’s Health Center for Pediatric IBD and Celiac Disease, please read the policy below and fill in the brief questions. Once your application is received, your Stanford Profiles, formerly Community Academic Profile, will be updated to reflect membership in our Center.

A) GENERAL:

The Stanford Children’s Health Center for IBD and Celiac Disease would like to identify individuals within the broad Stanford community whose research and/or patient care activities are relevant to IBD and celiac disease and to encourage them to apply for membership. Our Center aims to build a community across Stanford University to catalyze innovation and discovery in pediatric inflammatory bowel disease (IBD) and celiac disease to improve the health and well-being of children and their families affected by these diseases.

B) DEMOGRAPHIC SURVEY:

Why are we requesting the data, and how will the data be used?

The Stanford Medicine Children’s Health Center for Pediatric IBD and Celiac Disease is committed to advancing diversity, equity, inclusion and justice (DEIJ) in all aspects of our work supporting research, education and resources in IBD and celiac disease. Our Center commits to monitoring the diversity of its leadership, review boards, applicants, speakers and membership, creating metrics for improvement and modifying our practices and programs accordingly.

The data collected in the demographic survey will support us in evaluating our funding initiatives, identify gaps and barriers, and make changes to improve and ensure the equitable distribution of resources and opportunities for our members. It allows our Center to monitor if it is making progress over time in supporting scholars and grantees underrepresented in health fields and from diverse lived experiences. The data is collected for monitoring purposes only, and is not linked to grant applications or reviews.

C) ELIGIBILITY:

Faculty Member of the Center must:

Hold a doctoral degree: MD, PhD, or their equivalents.
Academic Status: Faculty including Clinical Educator, University Medical Line, University Tenure Line, and Non-Tenure Line (Research or Teaching)
Hold an appointment in the following lines within the SoM or Stanford University: CE/MCL/NTLR/NTLT/UTL

Trainee / Early Career Members of the Center must be a/an:

Undergraduate, Ph.D., or Medical Student or
Post-doctoral and Clinical Fellows
Instructor

D) PRIVILEGES:

Faculty Members of the Center receive the following benefits:

Access to biospecimens and clinical metadata
Invitation to apply for and receive grants and awards from the Center
Priority service at Center-sponsored activities
Invitation to Center Seminar Series, Symposia, and Retreats Assistance with large multi-disciplinary or multi-departmental grants (e.g., P01s, Center grants)
Membership listing on the Center website
Curated list of funding opportunities
Promotion of members through our quarterly newsletter who receive grants/awards

Trainee / Early Career Members of the Center receive the following benefits:

Invitation to Center seminars, symposia, and other sponsored events and opportunities
Priority access to Center programming and events
Invitation to apply for and receive grants and awards from the Center based on specific eligibility requirements
Alumni and peer networking opportunities
Access to mentorship opportunities within the Center

E) RESPONSIBILITIES:

Center members must when appropriate:

Participate in peer review of applications for Center funding mechanisms. (Applicable only to Members in CE/MCL/NTLR/NTLT/UTL lines).
Annually update Stanford Community Academic Profile, including publications.
Provide an annual report no later than 1 month after the end of the fiscal year, if you received funding from our Center. This brief report will list IBD- or celiac- related research funding and academic productivity.
Acknowledge the Center and respective grant mechanism in a publication of any material (i.e., grant applications, abstracts, presentations, publications, etc.), if your research project is funded by the Center or used Center resources or services.

Sunet ID*

Last Name:*

First Name:*

Email Address:*

What is your racial or ethnic group(s) do you identify with? (Mark all that apply)*

American Indian or Alaska Native (e.g., Navajo Nation, Blackfeet Tribe, Inupiat Traditional Gov’t., etc.)

Asian or Asian American (e.g., Chinese, Japanese, Filipino, Korean, Vietnamese, Indian, Pakistani, Sri Lankan, etc.)

Black or African American (e.g., Jamaican, Nigerian, Haitian, Ethiopian, etc.)

Hispanic or Latino (e.g. Cuban, Mexican, Puerto Rican, South or Central American, etc.)

Middle Eastern or North African (e.g., Lebanese, Iranian, Egyptian, Moroccan, Israeli, Palestinian, etc.)

Native Hawaiian or Pacific Islander (e.g., Samoan, Guamanian, Chamorro, Tongan, etc.)

White or European (e.g., German, Irish, English, Italian, Polish, French, etc.)

My race or ethnicity is best described as:

Prefer not to say.

Degrees:*

MD, PhD, etc.

School:*

Medicine, etc.

Select or enter value

Department (SUnet lookup)*

Practice at LPCH?*

Yes

No

Area of Expertise:*

Basic Science

Translational Research

Clinical Research

Population Health

Expertise Description:*

Please provide key terms or categories that correspond to your specific research experience and/or clinical focus.

I Agree to the Membership Policies Listed Above:*

Yes

No

Please Upload CV:*

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