Departmental Research Affiliate Request (Courtesy Affiliation)
Department/Program:
*
Your Name (Chair/Director completing the form):
*
First Name
Last Name
Your Email:
*
example@example.com
Name of Proposed Research Affiliate:
*
First Name
Last Name
Address of Proposed Research Affiliate:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail of Proposed Research Affiliate:
*
Length of Appointment (Start Date July 1, 2022)
1 year
2 years
3 years
Reason for request
Upload CV
*
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