Research & Scholar Activity Report

Research & Scholar Activity Report

Please use this form to record all research and scholarly activity since you were awarded through the Foundation for Women's Cancer/Foundation for Gynecologic Oncology/Gynecologic Cancer Foundation.

Name*

Credentials*

ex. MD, PhD, etc.

Preferred Email*

Phone Number*

Phone

Current Institution*

Type 'Retired' if no longer in practice or affiliated with any institution

Current Position*

ex. Professor, Associate Professor, Instructor, Department Chair, etc.

Place of Residence*

Where are you living currently? If outside of the US, please include the country. (City, State, Country)

ex.

Chicago, IL

Gangnam-gu, Seoul, South Korea

Oaxaca de Juarez, Oaxaca, Mexico

Award Year

What year did you receive your award?

Notable Findings, Discoveries, & Projects

Were there any notable findings, discoveries, or projects (research or otherwise) that came out of your research funded through the Foundation for Women's Cancer?

Grant Leadership

Grants for which you had a leadership role (PI, Co-PI, or site director) since receiving your award.

Respond with total number.

Funds Received for Research*

Total amount of funding you've received for research after being awarded by the FWC/FGO/GCF.

Respond with a total number.

Funds Received for Research directly related to your FWC/GCO/GCF Award*

Respond with a total number.

Funds Received for Clinical Trials directly related to your FWC/GCO/GCF Award*

Respond with a total number.

Funds Received for Clinical Trials*

Total amount of funding you've received for clinical trials after being awarded by the FWC/FGO/GCF.

Respond with a total number.

Are you still involved in gyn onc research?*

Yes

File Upload*

Use this to submit your updated CV & headshot (required) and any other supporting or relevant documents (optional).

Drag and drop files here or

Date*

Send me a copy of my responses

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