CariGenetics TRE Researcher Application Form

CariGenetics TRE Researcher Application Form

All researchers accessing the CariGenetics TRE are required to be a registered researcher. To be considered to become a registered researcher at CariGenetics, you must successfully complete the below application form.
Section 1 - Personal Details

Your personal details and contact information
Title
Name

First NameLast Name
Phone Number
Please enter a valid phone number with area code.Format: (000) 000-0000.
Email address at your main work or academic institution
example@example.com
Address at your main work or academic institution (This is your work or academic institution office address. This shouldn’t be your home address.)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Countries you may be accessing data from
Add any professional researcher profiles that prove where you work or study, for example ORCID or LinkedIn.
ORCID ID
LinkedIn profile URL
Add another (please specify)
Research focus
Section 2 – Professional details
Academic qualifications
A list of your undergraduate and graduate education; any postdoctoral training; or any other relevant training or courses
Employment history
A list, in reverse chronological order (most recent first), of all your professional appointments beginning with the current appointment. Please include your current position.
Publications
A list of (i) up to 5 of your publications most closely related to the types of research you may undertake using the CariGenetics TRE; and (ii) up to 5 other significant publications
Scientific conduct: Are you currently under investigation for scientific misconduct or has there been disciplinary action taken against you for professional misconduct in the last three years?
Additional information
Indicate any further details you wish to bring to our attention. This may include a list of up to five examples that demonstrate the broader impact of your professional activities or that demonstrate your abilities to work with the relevant data/samples in your proposed project. Examples could include, among others: innovations in teaching and training (e.g., development of curricular materials); contributions to the science of learning; development and/or refinement of research tools; computation methodologies, and algorithms for problem-solving; development of databases to support research and education; broadening the participation of groups underrepresented in science, mathematics, engineering and technology; and service to the scientific and engineering community outside of the individuals immediate institution.
Section 3 - Institution Details

Institution details for your affiliated institution
Institution Type
Institution Name
Job title
Institution registered address (The address at which the institution is registered for example, head office. This may be the same address as your office address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Registered Charity number or Company Registered number
Department or institution telephone number
Please enter a valid phone number.Format: (000) 000-0000.
Department or institution website address
Section 4 - Declaration
Please read the Privacy Policy here.
Privacy Policy
Accurate Information
Notification of Changes
Signature
Name

First NameLast Name
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate of Signature
Should be Empty:

CariGenetics TRE Researcher Application Form

Section 1 - Personal Details

Section 2 – Professional details

Section 3 - Institution Details

Section 4 - Declaration