2017 AACR Integrative Molecular Epidemiology Workshop: Bridging Cancer Biology and Precision Medicine. Deadline: Monday, March 13, 2017

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1 2017 AACR Integrative Molecular Epidemiology Workshop: Bridging Cancer Biology and Precision Medicine Deadline: Monday, March 13, 2017 Sample Copy of 2017 Workshop Application NOTE THAT THIS IS ONLY A SAMPLE COPY OF THE 2017 APPLICATION TO ASSIST YOU IN PREPARING YOUR APPLICATION. TO BE CONSIDERED FOR THIS WORKSHOP, YOU MUST APPLY THROUGH THE ONLINE APPLICATION SYSTEM ONCE IT IS OPEN. Contact Information and Area(s) of Research Contact Information Career Stage First (Given) Name: Last (Family) Name: Middle Initial(s): Prefix (Dr., Ms., Miss, Mr., Mrs., Prof., Rev., Sir): Current Position Title: Institution: Institution Address: City: State/Province: Zip Code/Postal Code: Country: Telephone: Home Phone: Fax: address: Alternate or Permanent Address: Applicant is a: PhD candidate MD candidate Post-doctoral fellow MD resident or fellow

2 Early-career scientist (terminal degree received < 5 years ago) or junior faculty Senior researcher (Academia) Senior researcher (Industry) Researcher with a terminal master s degree only, but with extensive experience Date of receipt of (or expected receipt of) final degree Field of degree Field(s) of Study (Check all that apply) : Molecular Epidemiology Genetic Epidemiology Genetics Biostatistics Molecular Biology Bioinformatics Other (Please specifiy): Ethnicity and Gender Race and gender information collected for statistical purposes only. Gender: Male Female Ethnicity: Individuals from groups considered to be underrepresented in cancer research (African-Americans, Hispanic-Americans, Native-Americans, Native Pacific Islanders/Hawaiians, and Alaska Natives), as defined by the NCI are strongly encouraged to submit applications. Caucasian African-American Hispanic Asian Native American Alaskan Native Native Pacific Islander Other (Please specifiy): Disability

3 Do you possess a physical handicap or disability that could be facilitated by special accommodation? Yes No Have you attended a related or similar workshop? Yes (If "Yes," please describe: ) No Have you used social media in a professional/scientific capacity? No Yes If yes, please describe (2-3 sentences maximum): C.V., Current Research, Participation Statement Curriculum Vitae (Upload via the online system once it is open) Please upload your personal curriculum vitae (c.v.). The c.v. must be in English and include a complete list of publications. NIH short form and biosketches will not be accepted. Upload the file as a *.pdf, file. The system cannot accept files larger than 5MB, therefore *.pdf files are preferred. Text should be created using word processing software and then converted to *.pdf. Avoid scanning text attachments to convert to *.pdf since that causes problems in the handling of the application. Click Save and Next to save and advance. Allowed File Formats: *.pdf Do NOT use any additional symbols or punctuation marks in your file name. A file name CV.pdf is acceptable. However, CV.LastName.pdf will generate an error during handling of the application. If you are unable to convert your word processing file to *.pdf, please your *.doc file to Lyngine Calizo, PhD, at lyngine.calizo@aacr.org. Description of Current Research Please summarize your current research and how participation in this workshop will further that research (300 word maximum): Reason for participation statement Submit a statement explaining why you wish to participate in this workshop (300 word maximum). Your statement should:

4 a) Describe your long-term research and career goals. b) Explain how participation in this workshop will help you to achieve these goals. c) Provide a self-assessment of your strengths and weaknesses and how this workshop will address your knowledge gaps. Letter of Recommendation PhD or MD candidates, post-doctoral fellows and MD residents/fellows, earlycareer scientists, junior faculty, or those with a terminal master s degree only must submit a letter of recommendation from their mentor, Program Supervisor, or Department Head. The letter may be uploaded online with the application or sent separately by . Your supervisor or mentor MUST complete and submit the required information no later than MONDAY, MARCH 13, 2017 (11:59 p.m., US Eastern Time), in order for your application to be considered complete. Otherwise, your application will be considered INCOMPLETE and NOT CONSIDERED for admission to the workshop. A letter of recommendation is not needed for senior researchers. If you are a senior researcher, please upload a document with the text Senior Researcher - Letter not required. UPLOAD your recommendation (upload via the online system once it is open): Upload the file as a *.pdf, file. The system cannot accept files larger than 5MB, therefore *.pdf files are preferred. Text should be created using word processing software and then converted to *.pdf. Avoid scanning text attachments to convert to *.pdf since that causes problems in the handling of the application. Click Save and Next to save and advance. Allowed File Formats: *.pdf Do NOT use any additional symbols or punctuation marks in your file name. A file name Recommendation.pdf is acceptable. However, Recommendation.LastName.pdf will generate an error during handling of the application. If you are unable to convert your word processing file to *.pdf, please your *.doc file to Lyngine Calizo, PhD, at lyngine.calizo@aacr.org. SEND your recommendation by If you or your mentor/supervisor/department head choose to send the letter separately by , please send a copy of your recommendation letter to Lyngine Calizo, PhD, at lyngine.calizo@aacr.org.

5 Recommender First Name: Recommender Middle Name: Recommender Last Name: Recommender Address: Recommender Phone Number: This document/letter that they prepare should include the following information: a) An assessment of the applicant s ability to think with originality and creativity b) Likelihood of the applicant s ability and chances to engage in multidisciplinary research in Integrative Cancer Epidemiology c) An assessment of the applicant s level of motivation and initiative as a researcher