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NEW MEMBERS APPLICATION FORM 2025- CBU CORTEX CLUB
Greetings!
Welcome to the Copperbelt University Cortex Club. The Copperbelt University Cortex Club is an Association that is run by students who have the love for neuroscience, neurodegenerative diseases, mental health, among others. We envision to inspire students who wish to become neurologists and neurosurgeons in future by learning more of what the brain is all about while still in med school. One of the Biggest events we host annually is the Brain Awareness week, which is filled with plenty of activities such as a Brain Bee, Match-past, Advocacy and raising awareness on Neurodegenerative Diseases, and many more! 
Below is the Application form for new members. Kindly answer the following few questions to be part of the Cortex in the 2025 Academic year. A response will be sent back to you after completing the application form and every member is required to pay a K50 yearly affiliation fee as part of the Cortex club.
Email *
FULL NAMES *
PHONE NUMBER (preferably your WhatsApp)  *
EMAIL *
YEAR OF STUDY *
PROGRAM OF STUDY (use abbreviations, eg MBCHB, BDS) *
INTERESTS IN THE CORTEX CLUB 
Why are you interested in being part of the first student-led Cortex Club at the Copperbelt University? (150 words maximum)
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INTEREST IN THE CORTEX CLUB 
Briefly explain how your interest aligns with the club's focus on neuroscience and mental health. (150 words maximum)
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BRAIN AWARENESS WEEK INVOLVEMENT 
Have you participated in previous Brain awareness weeks, or do you have any experience in advocating for neurodegenerative diseases or related topics?
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BRAIN AWARENESS WEEK INVOLVEMENT 
How do you envision contributing to and enhancing our annual Brain Awareness Week initiatives this year?
 *
SKILLS AND CONTRIBUTIONS 
What specific skills or talents do you possess that could contribute to the Cortex Club's mission and activities?
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SKILLS AND CONTRIBUTIONS 
Are there particular aspects of mental health or neuroscience advocacy that resonate with you?
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If yes to the above question, kindly mention a few. If no, type NIL. *
COMMITMENT AND AVAILABILITY 
Can you commit to actively participating in club meetings, events, and Brain Awareness Week activities?
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COMMITMENT AND AVAILABILITY 
Are you involved in other extracurricular activities that may impact your availability?
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FUTURE GOALS
How do you see your involvement in the Cortex Club shaping your future goals, especially in the fields of neuroscience or mental health?
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ADDITIONAL COMMENTS
 Is there anything else you'd like us to know about your passion for the brain and your potential contributions to the Cortex Club?
VOLUNTARY WORK
Have you ever Volunteered in any work before prior to applying to the Cortex club? (Yes or No. If yes, kindly mention any)
 *
Do you have any leadership skills or leadership experience? *
If yes to the above question, what position did you have and when was it and where exactly where you serving?
Do you have any Public Speaking Skills or experience? *
A copy of your responses will be emailed to .
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