THE CENTRE FOR PHARMACEUTICAL ONCOLOGY

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1 THE CENTRE FOR PHARMACEUTICAL ONCOLOGY Application for Membership Send Completed Form to: Name (Last, First): Current Position: o Professor o Associate Professor o Assistant Professor o Scientist o Research Associate o Post-Doctoral Fellow o MSc/PhD Student o Undergraduate Student o Health Professional o Other (please specify): Office and Laboratory/Research Location: o Leslie Dan Faculty of Pharmacy (Please specify room number): o Other Location (Please specify): Tel.: Primary Appointment/Affiliation: o Leslie Dan Faculty of Pharmacy including Department of Pharmaceutical Sciences at the University of Toronto o Other University of Toronto Faculty or Department (please specify): o Other University (please specify): 1

2 MEMBERSHIP CATEGORY Please indicate for which category of membership you are submitting an application (Please see descriptions of membership categories below): o Full Member o Associate Member o Full Trainee Member o Research Staff Member o Associate Trainee Member Please note: All members of the CPO must acknowledge their membership in any publications and presentations related to research that is conducted by the member that falls within the mission of the CPO. This is intended to increase awareness of the CPO within the scientific and broader public communities. Full Member. A full member is a faculty member with a primary or cross-appointment at the Leslie Dan Faculty of Pharmacy who is conducting cancer research. Faculty members who are full members of the CPO are eligible to apply as a principle investigator for pilot research grant support (when available) and the member s trainees are eligible to apply for scholarships or fellowships. A full member is eligible to access CPO infrastructure and may participate in all of the CPO activities. Associate Member. An associate member is a faculty member at the University of Toronto who is collaborating with a full member of the CPO to conduct cancer research. An associate member and their trainees may only access the infrastructure of the CPO through collaboration with a full member. An associate member is eligible to apply for pilot research funding (when available) only as a coinvestigator in collaboration with a full member who is the PI. Trainees of an associate member are not eligible to apply for scholarships or fellowships from the CPO. Full Trainee Member. A full trainee member is an undergraduate or graduate student or PDF who is supervised by a full member and is conducting cancer research. A full trainee member is eligible to apply for scholarships or fellowships from the CPO. Associate Trainee Member. An associate trainee member is an undergraduate or graduate student or PDF who is supervised by an associate member of the CPO and is conducting cancer research. An associate trainee member is not eligible to apply for scholarships or fellowships from the CPO. Research Staff Member. A research staff member is a research associate or technician supervised by a full or associate member and is conducting cancer research. Research staff members may participate in any of the activities of the Centre but are not permitted to apply for scholarships or fellowships. AREA(S) OF INTEREST IN PHARMACEUTICAL ONCOLOGY Please check all that apply: o Cancer biology o Cancer genomics/genetics o Animal models o Cancer target discovery o Synthesis of anti-cancer agents o Antibody Engineering 2

3 o Polymer chemistry o Nanomedicines o Pharmacokinetics o Imaging o Radiation medicine o Surgical oncology o Formulation science o Toxicology o Clinical trials o Experimental therapeutics o Immunotherapy o Cancer stem cells o Phototherapy o Patient care o Health economics o Public policy o Continuing Education o Other (please specify): RESEARCH DESCRIPTION Faculty members only. Trainees do not need to complete this section. Please provide a brief description (maximum of 100 words) of your research in the area of pharmaceutical oncology that can be posted on the CPO website with a link to your laboratory or research website. A detailed description of your research is not needed since this will be available through a posted link to your lab website; only a concise summary of your research interests in pharmaceutical oncology is needed. Please provide lab or research group website link: 3

4 ALIGNMENT WITH RESEARCH PRIORITIES OF THE CPO Please indicate which of the following initial priorities of the CPO that your research is most closely aligned. The CPO is also interested in members who have research interests outside these priorities since new priorities may develop over time depending on the expertise and resources of the membership. Please check all that apply: o Development of new and more effective treatments for metastatic breast cancer. o Development of new molecular imaging and therapeutic agents for pancreatic cancer. o Development of novel therapeutic and drug delivery strategies for ovarian cancer. o Other (Please specify): INTEREST IN PARTICIPATING IN CPO COMMITTEES Please indicate if you are interested in participating in the organizational structure of the CPO as a member of one of the following committees (please see descriptions of the committee structures and mandates below). o Executive Committee o Scholarships Committee o Research Training Committee Executive Committee: The executive committee is composed of 3 faculty members in the CPO (in addition to the Director), including two full members (see Membership categories) and the Chairs of the Research Training Committee and the Scholarships Committee. The Executive Committee manages the activities of the Centre including reviewing and approving applications for membership, overseeing planning for the research and educational mission and operation of the infrastructure as well as financial issues. Scholarships Committee: The scholarships committee is composed of 3-5 faculty members in the CPO (as needed) and is responsible for review and recommendations of applications from undergraduate and graduate students and post-doctoral fellows (PDFs) for scholarships that are supported by funds held within the CPO. The Scholarships committee works closely with the Awards Committee of Department of Pharmaceutical Sciences and with the Research Training Committee. Research Training Committee: The research training committee is composed of 4 faculty members including the Director of the CPO and 3 trainee members (one undergraduate student, one graduate student and one PDF) of the Centre and is responsible for promoting multi-disciplinary training in translational cancer research in the CPO. This committee also interacts with the CPD office at the Leslie Dan Faculty of Pharmacy on continuing education activities. 4

5 MEMBERSHIP APPROVAL Reviewed and approved by Executive Committee: o Date: Approved by Director, CPO: o Date: 5

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