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HSRI Affiliate Membership Application

Thank you for your interest in becoming an affiliate member of the Health Sciences Research Institute. Please complete the application below for affiliate membership. Please note: affiliate membership is available to community research partners, clinical partners, UC Merced researchers who do not have permanent PI status, and others at the discretion of the HSRI Executive Committee. Your application documents will be reviewed by our Executive Committee following our next membership application deadline (March 31 and September 30 each year). UC Merced graduate students are not eligible for affiliate membership and should apply instead for student membership. Please contact HSRI Executive Director Trevor Hirst thirst@ucmerced.edu if you have further questions. 

 

 
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(BS, Ph.D., MPH, MD, etc.)
Your phone number should be your office or business cell phone number and will be published on the HSRI website. If you do not wish to publish your phone number, please leave this blank or let us know that you do not wish your number to be made public.
Please provide your organizational website (e.g. company, hospital, clinic, or research website)
Please select your interests from the following list of research areas and medical conditions. Multiple selections are allowed. This information is used to sort website directory results so that visitors can see which members are interested in particular topics.
Please select from the following list of HSRI research cores and centers. Multiple selections are allowed. This information is used to sort website directory results so that visitors can see which members are engaged in our various cores and centers.
Please upload a PDF or MS Word document of your current CV/résumé/biosketch. This section is optional, but encouraged for clinical and professional researcher applicants.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.
Please upload a PDF or MS Word document that describes how your background, research (current or future interests), or community-based activities are related to health and the mission of HSRI. This statement will be reviewed by the HSRI executive committee.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.
Please upload a portrait headshot-style photograph for use on the HSRI website.
Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png.
Please tell us about yourself, and about your health research interests. This will be used to create your HSRI profile page and should be descriptive (not just a list of technical terms or bullet points) and accessible to a broad audience.