UVM Cancer Center Member Application

Membership Application

To apply for University of Vermont Cancer Center (UVMCC) membership, please submit the application below (note: you will be asked to upload your NIH biosketch at the end).

Contact Kate Webster, Executive Director of Administration by email at kate.webster@med.uvm.edu with questions. More information about UVMCC membership can be found here.

Membership Type

Member

Trainee Member

Are you affiliated with the University of Vermont?

Yes

No

Note: Trainee members must complete their Monicur profile before submitting their member application.

Once complete, please enter your Monicur ID (a six digit alphanumeric string) below to gain access to the remainder of this application. Your Monicur ID can be found on your Monicur dashboard directly below your name in the top left corner.

Monicur ID:

I have provided my Monicur ID above.

Contact Information

First Name:

Last Name:

Non-Affiliated Organization

NetID:

We have the following information currently on file for you:

Email: none provided
Phone: none provided
Website: none provided

Would you like to make changes?

We have the following information currently on file for you:

Email: none provided
Phone: none provided
Website: none provided

Would you like to make changes?

Yes

No

Preferred Email:

Preferred Phone:

(optional) Professional Website:

Trainee Member Details

Current Education Level:

Undergraduate Student

Medical Student

Graduate Student

Post-Doctoral Fellow

Please indicate your PI or mentor:

Please describe your work with the above PI/mentor:

Key areas of interest/focus (choose all that apply):

Laboratory research

Population health and behavioral research

Clinical research

Are you interested in speaking with a Cancer Center member who could serve as a mentor?

Yes

No

Member Details

We have the following information currently on file for you:

Primary Title:
none listed

Secondary Titles:
none listed

Degree(s):

Would you like to make changes?

We have the following information currently on file for you:

Primary Title:
none listed

Secondary Titles:
none listed

Degree(s):

Would you like to make changes?

Yes

No

Academic/Professional Primary Title
e.g. Associate Professor, Surgery

Academic/Professional Secondary Title(s)
e.g. Professor, Pulmonary & Critical Care Clinical
Professor, General Medicine

Degree(s)
e.g. MD

Demographics

Because the UVMCC is committed to inclusive excellence, we are collecting demographic information for our leadership and membership.

What is your ethnicity?

Hispanic or Latino

Not Hispanic nor Latino

Prefer not to answer

What is your race? (check all that apply)

If other, please specify (optional)

Do you identify as someone who has a disability?

Yes

No

Prefer not to answer

Are you a first-generation college student?

Yes

No

Prefer not to answer

Were you raised in a rural setting?

Yes

No

Prefer not to answer

Do you speak a language other than English?

Yes

No

If other, please specify:

Relevant Cancer Related Activities

We have the following information currently on file for you:

Your cancer related research, clinical research, or cancer care activities:

none provided

Your shortened (directory profile) research description:

none provided

Your community outreach activities:

none provided

Would you like to make changes?

We have the following information currently on file for you:

Your cancer related research, clinical research, or cancer care activities:

none provided

Your shortened (directory profile) research description:

none provided

Your community outreach activities:

none provided

Would you like to make changes?

Yes

No

Please describe your cancer related research, clinical research, or cancer care activities.

Please provide a condensed description of your research/work that you detailed above. This description will appear on your Cancer Center profile page. We encourage you to use terminology that would be appropriate for a general audience. Many use this space to provide information regarding postdoctoral training, other education, citations for cancer relevant work and/or links to publications.

Please briefly describe any community outreach activities. (optional)

Upload NIH Biosketch

Upload your NIH Biosketch.

If you would like to upload Other Support information please do so here:

Upload/Review Member Directory Photo

We are currently using the following image in our member directory:

Would you like to upload a new image?

We are currently using the following image in our member directory:

Would you like to upload a new image?

Yes

No

Upload your headshot (optional)

UVM Cancer Center Research Program Identification

Please indicate the UVMCC research program that you may feel is best aligned with your research and clinical expertise; each program area includes basic, clinical, and translational cancer research. For descriptions of programs, please refer to the UVMCC website research programs page.

Cancer Cell (CC)

Cancer Host and Environment (CHE)

Cancer Population Science (CPS)

Key Areas of Interest/Focus

We have the following information currently on file for you:

Would you like to make changes?

We have the following information currently on file for you:

Would you like to make changes?

Yes

No

Use your CTRL key (COMMAND key on a Mac) to select multiple detailed areas of focus:

Clinical Trials Participation

Are you now, or have you previously been involved in clinical trials research?

Yes

No

Training and Mentoring

Do you currently have trainees of any level (undergraduate, graduate, or medical student or research or clinical fellow) as part of your research program?

Yes

No

Please provide their name(s):

Are you recruiting/accepting new trainees into your research program in the next year?

Yes

No

Indicate your interest in training and mentoring (choose all that apply).

I am interested in accepting summer students.

I am interested in being a mentor for a trainee.

I am looking for graduate students for my research program.

Are you interested in being matched with a student participating in the UVMCC Summer Student Fellowship Program?

Yes

No

Bladder cancer
Brain cancer
Breast cancer
Colon cancer
Esophageal/stomach cancer
GYN oncology
Head & neck cancer
Hematologic malignancies
Liver/pancreatic cancer
Lung cancer
Melanoma/sarcoma
Pediatric oncology
Prostate cancer
Thyroid and endocrine cancers
Cancer genetics
Cancer immunology
DNA damage/repair
Epigenetics
Mechanisms of carcinogenesis
Medicinal chemistry/drug development
Oncogenic cell signaling
REDOX biology
Tumor microenvironment
Other
Cancer disparities
Cancer epidemiology
Cancer prevention & risk reduction
Cancer screening
Caregiver and behavioral intervention research
Environmental carcinogenesis
Health equity
Health services research
Implementation and dissemination science
Nutrition/obesity and cancer
Quality-based research
Rural healthcare
Tobacco cessation
Cancer immunotherapy
Cellular therapy
Coagulation and thrombosis/hemostasis in cancer patients
Early phase clinical trials
Experimental therapeutics
Integrative oncology
Survivorship/supportive care