Basic Science Trainee Committee Application Form Early-career basic research trainee comittee Applicant InformationName(Required) First Last Email(Required) Role(Required) MSc student PhD student Postdoc How long have you been in this role?(Required) Supervisor name(Required) Institution(Required) City(Required) Province(Required)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon8. Which committee role(s) are you interested in? (Please select all that apply)(Required) General member Co-chair Secretary Academic InformationThe following questions will help us understand why you wish to join the trainee committee. We are mindful of the time you have taken to apply, and don’t want to ask for too much of your time on these answers. Please feel free to keep your responses to 3-5 sentences!9. Why do you want to join the NMD4C basic research trainee committee?(Required)10. How will the experience from serving on this committee help advance your career in neuromuscular research?(Required)11. Which of the projects outlined in the committee objectives are you most excited to participate in?(Required)Please upload a copy of your academic CV(Required)Max. file size: 4 MB.Other Applicant Information (EDII)Why we are asking you to provide this information: In accordance with the network’s commitment to EDII, we strive to create an open, inclusive trainee group reflective of the geographical representation, and the diversity of the NM trainee population in Canada. Should you choose not to answer any of the questions below, this will not negatively impact your application. Data Privacy: Any information you choose to share with us will be used only by the NMD4C pre-clinical science leadership group and the coordinating staff and will not be shared either publicly or privately with any other members of the NMD4C. If you have any questions or concerns, please contact communications coordinator James Davis at *protected email*. 13. Please select a gender identity option that applies: Man Woman Non-binary Prefer not to disclose Other 14. Do you identify as Indigenous, that is, First Nation (North American Indian), Métis or Inuk (Inuit)? Yes No I prefer not to answer 15. The Employment Equity Act defines visible minorities as "persons, other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour". Do you identify as a member of a visible minority in Canada? Yes No I prefer not to answer 16. The Accessible Canada Act defines disability as “any impairment, including a physical, mental, intellectual, cognitive, learning, communication or sensory impairment—or a functional limitation—whether permanent, temporary or episodic in nature, or evident or not, that, in interaction with a barrier, hinders a person’s full and equal participation in society.” Do you identify as a person with a disability as described in the Act? Yes No I prefer not to answer NameThis field is for validation purposes and should be left unchanged.
