RePaDD Membership Application

Title

First Name*

Surname*

Email*

Phone Number*

Role Title:*

Academic Rank (if applic)

University/Organisation*

College/Faculty*

Department/Division*

Area of Professional Practice (ie. Doctor, Nurse, Allied Health Professional, Consumer Advocacy)*

Practice Setting (ie. Aged Care, Primary Care, Acute Care, Community)*

Please advise how you would like your name listed publicly on our website (if different from above)

Alignment with RePaDD's Research focus areas
Information on these focus areas can be found on the RePaDD website

Please select alignment with RePaDD's Research focus areas*

Palliative Care across the health systemDeath and Dying across the communityOnline evidence and practice translation

Which membership are you applying for?*

Full or associate membership (please complete section 1)Affiliate membership (please complete section 2)HDR student membership (please complete section 3)Centre contributor (please complete section 4)

Please note you only need to complete the relevant section for your application below.

Section 1: Application for Full or Associate Membership
(include a separate attachment if the space below is not sufficient, please find button at the bottom of this section)

1.1. Named on one or more research grants administered by Flinders University

Funding Body

Project Title

Amount

Your Role

Funding Body

Project Title

Amount

Your Role

Funding Body

Project Title

Amount

Your Role

1.2. Published either as main or co-author at least three recent research publications that are aligned with RePaDD’s research areas

Year of Publication

Type

Title

Where is it Published

Year of Publication

Type

Title

Where is it Published

Year of Publication

Type

Title

Where is it Published

1.3. Supervised at least one recent HDR student to completion in an area aligned with RePaDD research areas

Name of Student

Course

Thesis Title

Academic Institution

Name of Student

Course

Thesis Title

Academic Instution

Please upload any additional files here if necessary

Browse Files

Section 2: Application for Affiliate Membership

Please provide the following documents to support your application:

Your CV and
A one page summary of your research activities and publications

Please upload files here

Browse Files

Section 3: Application for HDR Student Membership

Applicants must be:

Enrolled as an HDR student undertaking a Masters or Doctorate degree on a part-time or full-time basis at Flinders University
Meeting the required milestones associated with their studies
Studying a research topic aligned with RePaDD research areas
Supervised by at least one full or associate RePaDD member

Course:

Thesis Title:

Supervisors:

Section 4: Application for Centre Contributor

4.1: Please select the category that aligns with your role:

Professional who facilitates the research activity of the Centre and those who actively contribute to the Centre's relevant research areas in a professional capacityCommunity member external to Flinders University and have an interest in the activities of the Centre

4.2: Provide a brief summary below as to how you see you contribute to the Centre's activities

Communications Consent

Do you consent to receive electronic communications and notices from RePaDD? This will include news, blogs, funding announcements, resources, events and support from RePaDD and other partner organisations.

RePaDD collects and uses your details as outlined in the Flinders University Privacy Policy. To unsubscribe, please email repadd@flinders.edu.au

Yes, I consentNo, I do not consent

Agreement

Please tick the box to the following questions*

I agree to abide by the conditions of the RePaDD membershipI confirm that the information provided in this form is true and correctI have provided a copy of my CV with this application (where applicable)I have attached additional supporting documentation (where applicable)

Signature*

Membership Application Form