Center for Psychiatric Neuroscience Membership Application

Please note: All membership applications must come from Northwestern University faculty or trainees. All applications that are accepted for membership will have a faculty profile link visible on our member page. For any questions about membership or applications questions/requirements please contact alexander.white@northwestern.edu.

First Name
Last Name
Middle Name/Initial
Degree
Email
Department
Division
Training lab you are associated with (if applicable)
Title
Institution (NU, NMH, Lurie, SRAL, other)
Campus (Chicago/Evanston/Other)
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Phone Phone - ### - ### ####
Research Statement
Please provide a brief statement (2-3 sentences) describing your psychiatric neuroscience relevant clinical and/or research activities and interests.
4-5 Keywords that indicate the area within psychiatric neuroscience that you work on
NIH BioSketch or CV (upload as Word document)

Attach Files
Active Grants/Other Support Page (upload; no signature needed)

Attach Files
Please Upload a Headshot/Photo for our website Membership Page - we will be posting all of our trainees on our website under our membership page.

Attach Files