NEC Society Research Incubator Clinician/Scientist Interest Form

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The NEC Society Research Incubator is an international, collaborative partnership of researchers, clinicians, and patient families. We are committed to accelerating NEC research. The Incubator provides a space for the NEC community to engage in research questions and collaborate from inception through implementation and evaluation.

Engagement Opportunities:

- Research Roundtables (quarterly, virtual via Zoom)
- NEC Investigator Mentorship Match
- Opportunity to present at NEC Society webinars, research roundtables, or Symposium
- Networking with clinician-scientists, nationally and internationally

Please fill out the information below and we will add you to the NEC Society email list. NEC Society staff will respond within 2 weeks of receipt. Please note, we are a small organization with limited staffing and do not have the capability to provide monetary or grant writing support for research done outside of our organization at this time.

Email *

What is your first name? *

What is your last name? *

What are your credentials? *

What is your institutional affiliation? *

What is your job title? *

What are your preferred research interest categories? (Check all that apply) *

Basic Science

Clinical

Qualitative

Quantitative

Translational

Patient Centered Outcomes Research (PCOR)/Comparative Effectiveness Research (CER)

Other:

Required

Please expand upon your preferred areas of clinical and/or research interests.

Do you work in a research lab? *

Yes

Are you interested in being involved in a mentorship program? *

Yes, as a mentor

Yes, as a mentee

Not interested at this time

Does your facility have a Family Advisory Council? *

Yes

Please share any additional information about your personal and/or professional experience with NEC:

Do you agree to have your name, institution, and email listed in the Incubator Directory for members? *

Yes

The NEC Society intentionally supports the empowerment of women, people from diverse backgrounds, the LGBTQ+ community, people with disabilities and groups that have been historically marginalized. Please review the NEC Society's Inclusivity Statement here https://necsociety.org/inclusivity-policy/ and agree to abide by these values by clicking below: *

I agree

A copy of your responses will be emailed to the address you provided.

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