Penn State Cancer Institute Membership Application

Section A

Date

Name

Please enter First, MI, Last

Degree(s)

Academic Rank

College/Campus

Department

Section/Division

Institution

Main Address

(Street, Building, Room, City)

Phone

Extension

Email

Section B

Referred by

Ongoing Penn State Cancer Institute Faculty Collaborators

Clinical Disease Team Preference

Breast	Experimental Therapeutics - Phase 1
Gastrointestinal	Genitourinary
Gynecologic	Head and Neck
Hematological Malignancies/BMT	NeuroOncology
Pediatric Cancer	Skin/Sarcoma
Thoracic

Provide a concise description highlighting your cancer related research interests.

Select the research program(s) you have an interest in by identifying a program of primary interest with a "1" and any others of secondary interest with a "2".

Cancer Control (CC)

Program Leaders: William Calo, PhD, JD, MPH, Joel Segel, PhD

Aim 1 focus: Determine the factors that are associated with cancer risk and detection; Aim 2 focus: Develop, test and conduct interventions to reduce cancer risk; Aim 3 Conduct interventions to reduce the burden of cancer treatment.

Mechanisms of Carcinogenesis (MC)

Program Leaders: Gary Perdew, PhD and Clare Sample, PhD

Aim 1 focus: Define the viral mechanisms that contribute to cancer or associated co-morbidity; ; Aim 2 focus: Elucidate the molecular mechanisms of environmental carcinogenesis; Aim 3 focus: Identify immunological mechanisms that modulate the carcinogenesis process.

Next Generation Therapies (NGT)

Program Leaders: Deborah Kelly, PhD and Patrick Ma, MD

Aim 1 focus: Determine precision targeting approaches for the molecular culprits of cancer; Aim 2 focus: Implement therapeutic interventions/clinical trials in the catchment area.

Which of the following Shared Resources do you currently use or may use in the future?

Biostatistics and Bioinformatics	Flow Cytometry	Genome Sciences
Metabolomics	Organic Synthesis

Do you have any recent cancer relevant publications?

Yes

Do you have any current or pending cancer relevant funding?

Yes

Please attach a copy of your current NIH Biosketch and/or Curriculum Vitae

Please attach a current NIH Other Support page or indicate your current and pending funding projects.

Contact Information