Research Affiliate Member (Investigator) Non-Employee Partner Access

Affiliate Members will be provisioned with the following:

Seattle Children's network access
Badge "on-site" access for research building and hospital (main campus) access
Seattle Children's email address

Application Outline:

General Applicant Information
Access Type
Summary of Assignments
Biosketch and training documentation
Attestation

Application Type*

New

Extension

Home Institution

Fred Hutch Cancer Center (FHCC)

Applicant First Name*

First Name

Preferred name if different from "Applicant First Name"

Applicant Last Name*

Applicant Initials

Please include initials in the following order: first initial, middle initial (if applicable), then last initial. For example if you name is Summer Smith please include the initials "SS" or if Summer Jr. Smith then "SJS".

Your initials will be displayed in the application status tracking dashboard that will be emailed to applicants submitting new applications and extension requests.

Job Title*

Work Email*

Please only provide work email ending in "@fredhutch.org"

Work Phone

Phone

Previously at Children's as a Non-Employee?*

Yes

No

Patient Contact*

Incidental or no patient contact

Will interact with patients for approved research specific tasks that are not direct patient care

Will provide services to patients not directly related to care

Provide direct patient care or services directly related to care on behalf of Seattle Children's Hospital

Do you need Epic access?*

I need to request Epic Access

No Epic Access Needed for any studies/roles

Active (selected by admin)

SC OnCore CTMS Access*

I need to request OnCore access

No OnCore access needed for any studies/roles

Active (selected by admin)

Summary of Assignments*

The purpose of the section is to summarize your assignments at Seattle Children's as an Affiliate Member. Please included 2-4 sentences.

Biosketch

A biographical sketch documents an individual's qualifications and experience.
If you do not have a biosketch please upload your CV instead.

Select "today's date" below as the date your biosketch/CV was uploaded.

File Upload -

Please upload your (1) Biosketch or CV

Please submit your application even if one of these items is not uploaded at the time of submission. Our team will follow-up with you.
Delay in submission of documents may delay the Affiliate Member onboarding process at Seattle Children's.

Drag and drop files here or

Fred Hutch Employee Attestation

Please review the information provided. Based on the applicants role at Fred Hutch, the applicant is qualified and authorized to access the protected health information of Seattle Children's patients in order to carry out their duties and responsibilities as a Fred Hutch employee or contractor.

Send me a copy of my responses