Membership Application UF Health Cancer Center 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. Last Name* First Name* UF ID (8 Digits Only)* Please enter your UF ID or Shands ID numberEmail* eRA Commons Login Name Public 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*Please select up to 10 research interest topics. If your interests are not listed, please contact researchadmin@cancer.ufl.edu. To select more than one research interest topic, please follow these instructions: After you select your first choice, click back into the field (not on the X), where the drop down menu will populate all remaining research interest topics. Then continue making as many additional selections as desired, repeating the previous process.Anesthesiology/Pain ManagementAngiogenesisApoptosis & Cell Death PathwaysBehavioral Determinants of CancerBioinformaticsBiostatisticsBone & Soft Tissue SarcomasBreastCachexiaCancer CommunicationsCancer GeneticsCancer InformationCancer PreventionCancer SurveillanceCancer SurvivorshipCancer SusceptibilityCardio-OncologyCell Signaling PathwaysChemotherapyDNA Damage & RepairDNA RecombinationDNA ReplicationDrug DesignDrug ResistanceEndocrineEnvironmentEpidemiologyEpigenetics & CancerEpigenetics & Gene RegulationEyeGastro-IntestinalGene TherapyGenetic Determinants of CancerGenital-Urinary/ProstateGynecologicalHead & NeckHealth DisparitiesHematologic Malignancies/Blood & Marrow TransplantImmunoregulation & SuppressionImmunotherapyInfection ControlIntegrative MedicineKidneyLeukemiaLiverLungLymphomaMetastasisMicroRNAsMolecular ChaperonesNanotechnologyNeuro-OncologyNoninvasive Imaging/TomographyNutrition, Dietary Supplements & CancerOncolytic Viral VectorsPainPalliative MedicinePediatric OncologyPlastic Surgery/ReconstructionPost-Transcriptional Gene RegulationQuality of Life IssuesRadiation OncologyRehabilitationRNA ProcessingSenescenceSkin/MelanomaStem CellStructural VirologySurgical OncologyTargeted Cancer TherapyThoracic OncologyThyroidTumor Virology/Virus-Host InteractionsVascular TargetingCancer 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. Statement 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 UFHCC Research Programs for which your ongoing research is best aligned. If you are unsure, please select "unsure."Please SelectCancer Control and Population Sciences (CCPS)Immuno-Oncology and Microbiome (IOM)Cancer Targeting & Therapeutics (CTT)Mechanisms of Oncogenesis (MOO)UnsureCV*Please upload your most current CV.Accepted file types: pdf, doc, docx, Max. file size: 125 MB.NIH Biosketch*Please upload your current NIH Biosketch.Accepted file types: pdf, doc, docx, Max. file size: 125 MB.Acknowledgement of data and photo use* By applying for Cancer Center membership, you grant permission for the UFHCC 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 UFHCC 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.
