Membership Application UF Health Cancer Institute Membership Application If you have any questions or need assistance with completing this form, please contact researchadmin@cancer.ufl.edu or call 352-273-8010. "*" indicates required fields Last Name*First Name*UF ID (8 Digits Only)*Please enter your UF ID or Shands ID numberEmail* eRA Commons Login NamePublic myNCBI Link*If you do not currently have a myNCBI Link, please write "none."Please identify all professional, cancer-related organizations in which you hold membershipe.g., AACR, ASCO, ASH, ASTRO, IASLC, ONS, etc.Research Interest Topics* Anesthesiology/Pain Management Angiogenesis Apoptosis & Cell Death Pathways Behavioral Determinants of Cancer Bioinformatics Biostatistics Bone & Soft Tissue Sarcomas Breast Cachexia Cancer Communications Cancer Genetics Cancer Information Cancer Prevention Cancer Surveillance Cancer Survivorship Cancer Susceptibility Cardio-Oncology Cell Signaling Pathways Chemotherapy DNA Damage & Repair DNA Recombination DNA Replication Drug Design Drug Resistance Endocrine Environment Epidemiology Epigenetics & Cancer Epigenetics & Gene Regulation Eye Gastro-Intestinal Gene Therapy Genetic Determinants of Cancer Genital-Urinary/Prostate Gynecological Head & Neck Health Disparities Hematologic Malignancies/Blood & Marrow Transplant Immunoregulation & Suppression Immunotherapy Infection Control Integrative Medicine Kidney Leukemia Liver Lung Lymphoma Metastasis Molecular Chaperones MicroRNAs Nanotechnology Neuro-Oncology Noninvasive Imaging/Tomography Nutrition, Dietary Supplements & Cancer Oncolytic Viral Vectors Pain Palliative Medicine Pediatric Oncology Plastic Surgery/Reconstruction Post-Transcriptional Gene Regulation Quality of Life Issues Radiation Oncology Rehabilitation RNA Processing Senescence Skin/Melanoma Stem Cell Structural Virology Surgical Oncology Targeted Cancer Therapy Thoracic Oncology Thyroid Tumor Virology/Virus-Host Interactions Vascular Targeting Please select up to 10 research interest topics. If your interests are not listed, please contact researchadmin@cancer.ufl.edu.Cancer Research Percentage*Help us understand the amount of your research that is focused on cancer-specific activities. <25% of my time 26-50% of my time 51-75% of my time 76-100% of my time Cancer-Relevant Publications*List your top three publications in the last five years that most demonstrate a strong cancer focus. Press the plus sign to add additional publications. Add RemoveStatement of Cancer-Related Activities*In the following space, please describe your cancer-related activities the committee should take into consideration when evaluating you for membership. Please summarize in lay terms the primary focus of your research and the cancer- relevance of that research.Program Alignment*Please identify the UF Health Cancer Institute Research Programs for which your ongoing research is best aligned. If you are unsure, please select "unsure."Please SelectCancer Control and Population Sciences (CCPS)Cancer Targeting & Therapeutics (CTT)Immuno-Oncology and Microenvironment (IOM)Mechanisms of Oncogenesis (MOO)UnsureCV*Please upload your most current CV.Accepted file types: pdf, doc, docx, Max. file size: 125 MB. NIH Biosketch (Optional)Please upload your current NIH Biosketch. (Optional)Accepted file types: pdf, doc, docx, Max. file size: 125 MB. Acknowledgement of data and photo use* By applying for Cancer Institute membership, you grant permission for the UF Health Cancer Institute Office of Research Administration to access your UF research portfolio. These data will be used in the membership review process and administrative reporting for Cancer Center Support Grant (CCSG) as required by the National Cancer Institute. Furthermore, your GatorOne photo may be utilized for your UF Health Cancer Institute member profile. If you wish to update this photo, you can do so at: https://my.bsd.ufl.edu/idcard/ mcphoto For questions regarding data usage and reporting please contact the Office of Research Administration 352-273-8010 or ResearchDevelopment@cancer.ufl.edu.
