YALE CANCER CENTER
333 Cedar Street, Suite WWW 205, New Haven, CT 06520-8028
RESEARCH MEMBERSHIP APPLICATION
NAME:
ACADEMIC TITLE:
DEPARTMENT:
MAILING ADDRESS:
E-MAIL ADDRESS:
TELEPHONE:
SECTION:
FAX:
UPI#: _____________________ eRA Commons ID: _______________________________
YALE EMPLOYMENT START DATE: _________________
ADMIN ASST or SECONDARY CONTACT (in case of urgent YCC need):
NAME: ____________________________________________________________________
EMAIL: ______________________________ TEL: _________________________________
UPI: _____________________ (Unique ID number found on your Yale Directory listing)
YCC RESEARCH PROGRAM AFFILIATION
(See attached list of Research Programs on page 4 and choose one to join):
Program Leader Applicant Signature/Date
Name:
Signature:
Complete this and the attached forms using additional pages as needed. Please provide:
1. An overall description of your cancer-related activities in the last four years, including cancer-related research and publications;
2. A listing of cancer-related teaching activities;
3. A listing of cancer-related national/community service (study sections, consultation to NCI, voluntary assistance to cancer organizations, etc.);
4. A listing of all grant support for the last five years and a listing of pending applications. Include grant number and, if appropriate, funding source, project title, role in project, percent effort, period of award, and annual direct costs;
5. A current curriculum vitae and bibliography;
6. An NIH-formatted Biosketch
Return all documents to: Christina Dreyfus at christina.dreyfus@yale.edu
or P.O.
Box 208028, 333 Cedar Street, New Haven, CT 06520.
Checklist:
[ ] Signed Application Form
[ ] Curriculum Vitae & Bibliography
[ ] NIH Formatted Biosketch
[ ] Description of cancer-related research and activities
[ ] Letter from Program Leader with signature

APPLICATION FOR RESEARCH MEMBERSHIP IN
THE YALE CANCER CENTER (YCC)
Research Members are individuals who do not meet the criteria for Membership, but who meaningfully contribute to the activities of the YCC. Research Members typically are engaged in relevant basic or population science research in cancer.
Eligibility
Research Members must:
1. Be affiliated with the Yale School of Medicine and
2. Provide substantive basic, population, scientific or administrative expertise to the overall research mission of the YCC.
In addition, Research Members should:
1. Contribute to the peer-reviewed cancer literature or
2. Participate on an extramural cancer-relevant peer-reviewed grant or
3. Contribute to YCC intervention (therapeutic or non-therapeutic) cancer clinical trials
Expectations
Research Members are encouraged to:
1. Participate in clinical, population science and/or laboratory cancer research;
2. Participate in Center, program or disease unit meetings, retreats, and symposia;
3. Participate in Center internal review panels and other committees;
4. Submit in a timely and accurate manner, annual and special requests for updates on
Research Progress, Other Support, Publications, Curriculum Vitae and Biosketches;
5. List YCC affiliations on curricula vitae and biosketches;
6. Acknowledge membership and YCC support, in publications, abstracts, posters, and presentations.
Privileges
Research Members will be entitled to receive:
1. Ability to apply for Pilot Grants with a YCC Member as co-PI;
2. Access to YCC administrative resources and personnel;
2. Enhanced opportunities to develop collaborative research efforts;
3. Facilitated access to clinical populations for clinical research studies;
4. YCC publications, announcements of availability of clinical awards and grants;
5. Public Relations support;
6. Invitation to YCC lectures, Grand Rounds, meetings and disease team conclaves.

Application Process
1. For questions please contact Edward Snyder, Chair of the Membership Committee at (203)
688-2441, edward.snyder@yale.edu
; or Christina Dreyfus, Yale Cancer Center Program
Coordinator at (203) 737-8375, christina.dreyfus@yale.edu
.
2. Each applicant must submit:

A fully completed, signed application form;

A curriculum vitae including bibliography;

An NIH-formatted Biosketch;
 A description of the applicant’s cancer-related activities. The cancer focus of the applicant’s activities and its relation to the mission of the YCC should be made clear in the description;

A listing of any cancer-related grant support;

A written paragraph of support from the applicable Research Program leader.
3. Send 1 copy of the completed and signed application to Christina Dreyfus at christina.dreyfus@yale.edu
or P.O. Box 208028, 333 Cedar Street, New Haven, CT 06520.
4. The Chair of the YCC Membership Committee will review and approve all applications.
5. The Chair of the YCC Membership Committee will notify applicants of the decision by letter.
6. Research Membership can be maintained as long as the individual fulfills the criteria necessary for the initial appointment. All YCC members will have their membership status reviewed at least every 2 years.

YALE CANCER CENTER
RESEARCH PROGRAMS
PROGRAM LEADERS YCC PROGRAM
Genomics, Genetics and Epigenetics Lajos Pusztai, M.D., D.Phil.
Marcus Bosenberg, M.D., Ph.D.
Cancer Immunology Lieping Chen, M.D., Ph.D.
Madhav Dhodapkar, M.B.B.S.
Cancer Prevention and Control
Developmental Therapeutics
Melinda Irwin, Ph.D.
Xiaomei Ma, Ph.D.
Karen Anderson, Ph.D.
Barbara Burtness, M.D.
Virus and Other Infection-Associated Walther Mothes, Ph.D.
Cancers Wendell Yarbrough, M.D.
Radiobiology and Radiotherapy Peter Glazer, M.D., Ph.D.
Joann Sweasy, Ph.D.
Signal Transduction David Stern, Ph.D.
Daniel Petrylak, M.D.

YALE CANCER CENTER
RESEARCH MEMBERSHIP APPLICATION
PROGRAM LEADER LETTER OF SUPPORT
To be completed by Research Program Leader
Provide a paragraph to substantiate why Program membership is appropriate.
Name of Applicant: _____________________________________________________
Research Program _____________________________________________________

YALE CANCER CENTER
RESEARCH MEMBERSHIP APPLICATION
APPLICANT STATEMENT- CANCER-RELATED RESEARCH FORM
Provide a general description of your cancer-related research and activities.
IMPORTANT: Please highlight three key words that can be used for indexing.
Name of Applicant: ____________________________________________________
Research Program: ____________________________________________________
Key words:
1)
2)
3)
1. An overall description of your cancer-related activities in the last four years, including cancer-related research and publications (Please note: This paragraph may be used for announcements.)
2. A listing of cancer-related teaching activities
3. A listing of cancer-related national/community service (study sections, consultation to NCI, voluntary assistance to cancer organizations, etc.)
4. A listing of all grant support for the last five years and a listing of pending applications. Include grant number and, if appropriate, funding source, project title, role in project, percent effort, period of award, and annual direct costs.