Application to Become a Member Institution
Please read the IUPLR Program Goals, Membership Guidelines and Governance document at http://iuplr.uic.edu/docs/default-source/default-document-library/iuplr-member-guidelines.pdf?sfvrsn=4 before applying to become an IUPLR member institution. Please attach all supporting documents to this application if necessary.
Center/Department Name *
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University Name (If applicable)
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Director Name *
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Center Address *
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Email *
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Phone *
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Website *
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Mission Statement/Description of Center *
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Copy Paste Curriculum Vitae of Director *
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Name of Main Administrative Contact *
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Title of Main Administrative Contact *
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Email of Main Administrative Contact *
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Phone of Main Administrative Contact *
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List of key personnel (Include Name, title, email, address, and telephone number) *
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List of faculty associates, affiliates, and fellows *
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Description of governance structure *
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List fellowship programs, if applicable *
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List of conferences, seminars and related activities held in the past three years *
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List recent or past activities that involved community-based organizations or policy-related activities *
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List publications *
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List on-going research projects *
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What collaborative research projects are you interested in pursuing through IUPLR? *
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What is your center or department's total annual budget? *
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Center or Program Director Name *
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