The Ohio State University
Comprehensive Cancer Center (OSUCCC)
MEMBERSHIP APPLICATION
NAME (include degree(s):
ACADEMIC TITLE:
DATE OF BIRTH*:
Note: This information is used by the OSUCCC Grants and Award Committees for reviewing members against sponsor
criteria for funding or prestigious award opportunities. This information will be kept confidential.
eCommons Name:
Publication Name (i.e. SmithJL):
MAILING ADDRESS:
OFFICE PHONE NUMBER:
(614)
FAX NUMBER:
(614)
E-MAIL ADDRESS:
COLLEGE:
DEPARTMENT (TIU):
DIVISION (if applicable):
Please provide a brief summary (less than 100 words) of your cancer-relevant research interests:
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Indicate which OSUCCC Research Program you believe is most aligned with your research interests:
Program
Program Leader(s)
-------------------------------------------------------------------------------------------------------------------------Cancer Control
Electra Paskett, PhD / Mary Ellen Wewers, RN, PhD
Translational Therapeutics
David Carbone, MD, PhD / Denis Guttridge, PhD
Leukemia Research
John Byrd, MD / Michael Grever, MD
Molecular Biology & Cancer Genetics
Michael Ostrowski, PhD / Matt Ringel, MD
Molecular Carcinogenesis & Chemoprevention
Steven Clinton, MD, PhD
Check the OSUCCC Shared Resources/Services/Cores you would anticipate using:
Analytical Cytometry
Behavioral Measurement
Biomedical Informatics
Biospecimen Services
Biostatistics
Clinical Treatment Unit/Clinical Trials Processing Unit
Clinical Trials Office
Comparative Pathology and Mouse Phenotyping
Genetically Engineered Mouse Modeling
Genomics
Leukemia Tissue Bank
Medicinal Chemistry
Microscopy
Nutrient and Phytochemical Analytics
Pharmacoanalytical
Proteomics
Small Animal Imaging
Solid Tumor Translational Science
Targeted Validation
Please provide a listing of all ACTIVE research funding (include grant title, sponsor, grant number,
total amount and project period):
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GENERAL RECRUITMENT INFORMATION (Newly recruited faculty):
A. What date did you join the faculty of OSU?
B. If appropriate, where is your current or proposed laboratory space located?
Building
Room number
NSF (net square feet)
a.
b.
c.
C. Briefly describe the components of your recruitment package?



Research personnel support
Equipment
Other start-up
Please attach a copy of your CV to this application and return by email to Mary Beth
Beguin (marybeth.beguin@osumc.edu)
OSU Comprehensive Cancer Center
650 Ackerman Road
Columbus, OH
614-293-5153
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FOR OSUCCC OFFICE USE ONLY:
Membership Category:
FULL
ASSOCIATE
INTRODUCTORY
STAFF
APPROVALS:
OSUCCC Program Leader(s)
Date
OSUCCC Program Leader(s)
Date
Michael A. Caligiuri, M.D.
Director, OSUCCC
Date
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