APPLICATION FOR MEMBERSHIP Categories of Membership (please check one): _____ Investigator _____ Associate Investigator _____ Affiliate Date: Name/Degree(s): Academic Title: Department: Mail Code: Room No: Telephone: Fax: E-mail: DESCRIPTION OF CANCER RELATED RESEARCH: DESCRIPTION OF INTERDISCIPLINARY OR COLLABORATIVE CANCER-RELATED RESEARCH WITH OTHER MEMBERS OF THE UCCCC: FUNDING WITHIN THE PAST 3 YEARS: PENDING FUNDING: 1 PLEASE INDICATE WHICH OF THE UCCCC RESEARCH PROGRAMS IS MOST RELEVANT TO YOUR INTERESTS: _____ MMC: Molecular Mechanisms of Cancer (Suzanne Conzen, MD, Kay Macleod, PhD) _____ HHM: Hematopoiesis & Hematological Malignancies (Wendy Stock, MD, Lucy Godley, MD/PhD) _____ IC: Immunology and Cancer (Thomas Gajewski, MD, PhD) _____ PhET: Pharmacogenomics and Experimental Therapeutics (Walter Stadler, MD, M. Eileen Dolan PhD) _____ AI: Advanced Imaging (Gregory Karczmar, PhD, Heber MacMahon, MD) _____ CPC: Cancer Prevention and Control (Habibul Ahsan, MBBS, MMEDSc, Andrea King, PhD) _____ Non-Aligned THE UCCCC CORE FACILITIES ARE LISTED BELOW. PLEASE CHECK THOSE YOU ARE CURRENTLY USING AND THOSE YOU MIGHT USE IN THE FUTURE. MAKE KNOWN YOUR INTEREST IN NEW CORE FACILITIES UNDER “OTHER” _____ Biostatistics Core Facility _____ Cancer Clinical Trials Office (CCTO) _____ Epidemiology and Research Recruitment Core _____ Cytometry and Antibody Technologies _____ Genomics Core Facility _____ Human Immunologic Monitoring and cGMP Facility _____ Human Tissue Resource Center _____ Integrated Microscopy Facility _____ Integrated Small Animal Imaging Research Resource _____ Pharmacology Core Facility _____ Image, Computing, Analysis, and Repository Facility _____ Transgenic Mouse and Embryonic Stem Cell Facility _____ Other ___________________________________________________ PLEASE RETURN THE FIRST TWO PAGES OF THIS APPLICATION AND YOUR CURRICULUM VITAE TO: PATRICIA GEIGER PROJECT ASSISTANT, UCCCC ROOM: H212 MC 1140 PHONE: 773.702.6180 FAX: 773.702.9311 E-MAIL: pgeiger@medicine.bsd.uchicago.edu 2 UCCCC MEMBERSHIP The mission of the UCCCC is “to elucidate the determinants of cancer, to develop cures for cancer and to prevent cancer through innovation and collaboration.” Cancer Center members are expected to contribute to this overriding objective through a broad range of clinical and research activities including: Stimulating, supporting, and facilitating collaborative interdisciplinary research in cancer; Transforming discoveries made in the laboratory, the clinic and the community into new applications that enhance cancer prevention, diagnosis and care; Applying the modern techniques of basic, clinical and population science to the study of human cancer and using them to benefit all populations affected by cancer and to understand and eliminate disparities in cancer care and health differences between diverse population groups; Conducting multi-disciplinary clinical treatment programs that provide patients with the most appropriate and effective combinations of advanced therapies available; Providing access to clinical trials to community oncologists and all populations—including minority communities—via a network of affiliated hospitals; Initiating and developing cancer prevention, risk assessment and control research at the University of Chicago and throughout the Chicago metropolitan area; and Providing education and training in cancer research and advanced cancer care for basic scientists, clinical investigators and health care professionals at all levels of training. Benefits of Membership In addition to the intangible benefits such as collegial interaction with basic, clinical and population researchers, UCCCC membership provides a number of more tangible perquisites such as: Access to UCCCC Shared Resources with a UCCCC co-pay o Biostatistics Core Facility o Cancer Clinical Trials Office (CCTO) o Cytometry and Antibody Technologies o Genomics Core Facility o Human Immunologic Monitoring and cGMP Facility o Human Tissue Resource Center o Integrated Microscopy Facility o Image, Computing, Analysis and Repository Facility o Pharmacology Core Facility o Integrated Small Animal Imaging Research Resource o Transgenic Mouse and Embryonic Stem Cell Facility Access to developing Cores: o Epidemiology and Research Recruitment Core o Human Imaging Research Office o Bioinformatics 3 Start-up funds for new faculty: The UCCCC partners with a member's primary department in providing start-up funds for faculty involved in cancer research, including: o Research funds for pilot projects; o Research funds for innovative, early phase clinical trials; o Seed funding for data generation in preparation for large multidisciplinary, multidepartmental grants (e.g., SPORES, P01s, Center grants); o Pre- and post-award support in the submission and administration of multidisciplinary, multidepartmental grants (e.g., SPORES, P01s, Center grants). UCCCC staff will assume responsibility for budget preparation, collection of all grant materials (biosketches, other support, etc.), grant compilation and submission, and preparation and submission of progress reports/non-competing renewals; o Access to program-specific activities, such as seminars, retreats, journal clubs, and travel funds; and o Access to UCCCC activities, such as the UCCCC Seminar Series and the UCCCC Translational Conference. Process Prior to initiating the official membership process, each applicant should contact the leader of the program they wish to join. He or she should describe his or her qualifications, cancer research interests, and potential collaborative activities with current Cancer Center members. All applications are reviewed and voted on by the Cancer Advisory Committee (CAC). UCCCC Membership – Eligibility UCCCC membership is a formal secondary appointment within the University. To be eligible for UCCCC membership, an investigator must be engaged primarily in cancer-focused research; that is, cancer must be the investigator’s principal research interest. Basic, translational, clinical or population-based cancer researchers are eligible for UCCCC membership in one of the following three categories: Investigators are faculty members who have current cancer-related, peer-reviewed funding from a national funding agency (as specified in NCI Guidelines) as a principal investigator OR are the principal investigator of a peer-reviewed, investigator-initiated clinical research protocol (i.e., approved by NIH, NCI, FDA, VA, ACS or the Clinical Trials Review Committee of the UCCCC) OR have had such cancer-related, research support OR chaired a clinical trial within the past 3 calendar years and intend to continue in cancer research. Associate Investigators are faculty members who have not had cancer-related, peer-reviewed national funding as a principal investigator within the past 3 years OR who have not served as principal investigator on an investigator-initiated peer-reviewed clinical protocol, but who have demonstrated an interest in cancer research OR have critical skills, knowledge, and/or resources that contribute to the Comprehensive Cancer Center's mission of collaborative cancer research. (Most junior faculty applicants fall into this category.) Affiliate membership is open to: Faculty from outside institutions affiliated with the University of Chicago (e.g., Argonne); and Current UCCCC investigators or associate investigators whose current research has evolved 4 and is judged as lacking in cancer focus, but who indicate an interest in remaining as Cancer Center members and intend to increase their cancer-related work. Membership is then re-evaluated within 1-3 years. The benefits of Affiliate Membership include: Access to UCCCC Shared Resources at UCCCC member rates; UChicago faculty rates or discounted rates if collaborating with a UCCCC investigator or associate investigator. (For affiliate members from outside institutions.); Access to program-specific activities, such as seminars, retreats, journal clubs, and travel funds; and Access to UCCCC activities, such as the UCCCC Seminar Series and the UCCCC Translational Conference. In exceptional situations, affiliate members may be considered eligible to compete for Cancer Center RFAs and pilot and other discretionary funds. This is determined on a case-by-case basis, subject to approval by the Executive Committee. Affiliate members can be appointed by the UCCCC (Executive Committee) without formal secondary appointments through the Provost Office, and are not required to be aligned with specific research programs Membership Responsibilities Membership has both its privileges and responsibilities, and members (new and established) must meet and maintain the standards established by the UCCCC, its senior scientific leadership, and the leaders of their primary programs. In general, all members belong to one of the six established programs. Basic requirements of UCCCC membership are as follows: Participation in your program's activities (seminars, workshops, retreats, journal clubs) Research and/or clinical interactions and collaborations with members in your program as well as members in other UCCCC programs Compliance with all policies and procedures of the UCCCC Data and Safety Monitoring Plan as related to the conduct of clinical trials including: o Response to and compliance with recommendations of CTRC and SAM (including study closure) and UCCCC conducted audits; and o If involved in clinical activity, participation in the UCCCC audit program as an auditor. Membership Review On an annual basis, at the time of submission of the competing or non-competing Cancer Center Support Grant, current membership rosters are reviewed. At that time, members may be asked to update the cancer relatedness of their activities. Continued membership will require documentation of a cancer focus and collaboration with other cancer members. At the time of re-appointment (within their primary departments) or promotion, each investigator or associate investigator must apply for renewal of Cancer Center membership by completing a brief form, which describes his or her continued participation in cancerrelated research. This should also include a description of programmatic interactions and usage of UCCCC core facilities. An updated CV and research support documentation is also required. Reappointment in the UCCCC requires approval of the Cancer Advisory Committee. 5 For each member requesting renewal of his/her appointment, Program Leaders complete a standard checklist to indicate the extent to which the investigator has actively participated in Cancer Center activities. An Associate Investigator may be considered for advancement to the Investigator level annually if he or she meets the criteria specified above for appointment as an Investigator. If at any time, and following review of circumstances and/or appeal, the Clinical Research Advisory Committee (CRAC) finds an investigator to be noncompliant with the DSM (DSM) Plan guidelines, the CRAC will recommend that the CAC suspend membership privileges. All changes in membership including suspension of membership privileges require review and a vote by the CAC. 6