ALL Cancer CARE Workshop Application

URL

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Preferred Name*

First Last

Professional Email*

Personal Email*

Telephone Number*

I consent to receive text messaging with workshop updates*

BNGAP username*

If you have not yet registered for BNGAP.org, please write “Not registered”

Completed Professional Degree*

Current professional role*

Professional Title*

Department or Specialty*

Primary Institutional Affiliation*

Other Institutional Affiliation*

Mailing Address*

City State / Province / Region ZIP / Postal Code

Race/Ethnicity

Select all that apply

Asian
Black/African-American
Hispanic/Latinx
Native American/Alaskan Native
White
Prefer not to answer
N

Specify if your race/ethnicity is not listed or if you wish to further describe

Gender Identity

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What are your pronouns?

Specify if pronouns not listed or you wish to further describe

Sexual Identity

Specify if sexual identity not listed or you wish to further describe

Age

Do you have a disability

If yes, please recommend any accommodations that will facilitate your in-person participation.

Number of years of experience in cancer research*

Number of years of experience in cancer research as a principal investigator*

How many R01 grants as a principal investigator have you received?*

Upload your CV here (Word or pdf format)*

Max. file size: 32 MB.

• Describe any experience you have had conducting cancer research and/or research with populations that experience poor access to care or are at risk for disparate health and cancer care. Please include any significant experiences that are not described in your CV. [<300 words]**

• Please upload a 1 page document containing your research question, research proposal, or Specific Aims for a project you are currently developing. (Word or pdf format)*

Max. file size: 32 MB.

• Would you like to have your research question, research proposal or Specific Aims reviewed with an ALL Cancer CARE team member, after the workshop?*

Regarding your research proposal, please select up to 2 relevant research content areas discussed in your proposal*

• What populations are the focus of your research?*

Regarding your research proposal, please select up to 2 relevant research approaches discussed in your proposal*

Basic Science
Behavioral Health
Clinical Research
Community Based Participatory Research
Epidemiology
Translational Research
Not Listed

Describe the skills you currently possess to complete research in the cancer care continuum (prevention, screening, treatment or survivorship). [<300 words]*

Describe the skills you need to acquire to become a productive researcher in the cancer care continuum (prevention, screening, treatment or survivorship). [<300 words]*

Describe your personal motivation (personal background or experience) for participating in this workshop. (<300 words)*

Describe any research resources available to you to conduct independent research and/or write grant proposals addressing the cancer care continuum. [<300 words]*

Describe any community-based resources available to you to conduct independent research and/or write grant proposals addressing the cancer care continuum. [<300 words]*

Add any additional comments you would like to share with us. [<200 words]*

I would like to be included in a directory of researchers interested in cancer research.*

Are there any people or listservs we should contact to invite to participate in the workshop? Please describe.*

If a person or organization referred you to apply for this workshop, please list their name

ALL Cancer CARE Workshop Application

ALL Cancer CARE Application