New and Established Investigators Network of Expertise (NoE) Application
Thank you for your interest in joining the New or Established Investigators NoE! We are excited that you are interested in joining our network of dedicated members who share a mutual passion for dissemination and implementation work. Please fill out the application below. If accepted, the information you provide will be featured on our NoE pages on the SIRC website with your consent. The information you provide will be extremely helpful for identifying mentorship matches and supporting general networking among SIRC members.
Sign in to Google to save your progress. Learn more
Please send your CV to with "CV for New/Established NoE Application" in the subject line.
Which NoE are you applying for?
Clear selection
Name & Educational Degree: *
E-mail: *
Role/Position(s): *
University, Organization, and/or Program Affiliation(s): *
Please share 3-5 keywords that describe your areas of research expertise:
Have you secured any dissemination & implementation-related funding? If yes, please specify your primary D&I grants. *
Please share a link to your website or university profile: (if available): *
Please share your social media profiles (if available): *
If accepted, would you consent to having the information above featured on our SIRC Investigators NoE Website? This will be particularly helpful for identifying mentors for SIRC NoE mentorship. Please write in any information that you DO NOT want posted on the SIRC website:
How has dissemination and implementation influenced your thinking about research to date? *
Which initiatives are you willing to participate in as an active member of the NoE (check all that apply)? *
Which mentorship models would you be willing to provide for other SIRC members?
How frequently are you willing to provide mentorship?
Please share 1-2 sentences about your D&I research interests that you would like us to consider in making mentorship matches.
What are you specifically able to provide mentorship on? Possible examples include: general mentorship (e.g., long-term career planning, prioritizing projects); research collaboration opportunities; learning more about D&I; grant writing; workshopping an idea; dissertation execution mentorship on.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Google Apps for UCLA. Report Abuse