Child Health Research Institute (CHRI)
Child Health Research Institute (CHRI) Membership Form
Application for new members
Select information from this application will appear in your CHRI Member Profile on our public webpage
Today's Date: 11/17/2024
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Required Fields
Last Name:
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First Name:
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Middle Initial:
Title:
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Credentials:
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Campus/Office Address:
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City:
State:
Zip:
Phone:
Fax:
Email:
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Relevant Professional Social Media Links:
Please select by rank the top 3 area(s) of emphasis most closely align with your research interests:
(only one area is required, ranking others is optional):
Rank 1
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Select One
Pediatric Cancer
Genetics, Development and Exposures and Injuries
Lifespan Diseases
Health Services, Policy & Population Health
Heart Diseases
Global Health
Rank 2
Select One
Pediatric Cancer
Genetics, Development and Exposures and Injuries
Lifespan Diseases
Health Services, Policy & Population Health
Heart Diseases
Global Health
Rank 3
Select One
Pediatric Cancer
Genetics, Development and Exposures and Injuries
Lifespan Diseases
Health Services, Policy & Population Health
Heart Diseases
Global Health
Please provide a
brief description
of your pediatric research interests and/or current research summary:
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Please provide
a few keywords
that describe your pediatric research interests:
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Please list your active collaborations with other UNMC / CHMC / CHRI:
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Membership Type:
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Select One
Full
Associate
Affiliate
Trainee
Community
SCOPUS Author ID (if applicable):
ORCID iD (if applicable):
Campus/College:
Campus
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UNMC
UNO
UNL
UNK
Institute other than Nebraska
Name of Other Institution:
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College/Department:
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Division and/or Specialty:
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Department/Office Administrator/Grants Manager:
Name:
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Phone:
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Email:
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Link to professional bio on institutional webpage (if applicable):
Recent Publications
Active Grants
Please attach your biosketch or CV:
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Upload your NIH-style biosketch or curriculum vitae as a Word document (.docx or .doc) or as a PDF file.
The filename must be unique, so please include your name as part of the filename.
Do not use periods or special characters in your filename (e.g. use smith-john-112818.pdf not smith.john.11.28.18.pdf).
NIH Resource - https://grants.nih.gov/grants/forms/biosketch.htm
Community Organization (if applicable):
Provide any additional relevant information or links to your bio, your organization or your work (If applicable):
If you have any questions, please contact:
Jaclyn Ostronic: jaclyn.ostronic@unmc.edu
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Form last updated 1/18/23
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