Form
Name
First Name
Last Name
Email
example@example.com
Affiliated organisation
Are you employed by
A university
NHS organisation
Private sector healthcare provider
Other
Do you have PhD
Yes
No
Type option 3
Type option 4
Do you have a professional doctorate?
Yes
No
Type option 3
Type option 4
If you have a PhD, would you be interested in examining PhDs?
Yes
No
Type option 3
Type option 4
Would you be interested in being an academic mentor for someone outside your organisation?
Yes
No
Unsure
Type option 4
Are you interested in collaborating in research through (please tick all that apply- please note that you don't need a PhD or professional doctorate to collaborate in research)
Being a co-applicant on large scale grant funding applications
Supporting grant applications but not as co-applicant (e.g linked clinician)
Developing research ideas with a group of colleagues
Helping gather data or write reports for ongoing research
Other
Please enter your areas of research interest below
Submit
Should be Empty: