Please provide the following to register for the 2020 Investigator Award competition: First Name * Last Name * Award Category * Mentored Clinician Scientist Clinician Scientist Education Level * Allied Health, PhD MD Both MD and PhD Nursing, PhD PhD Email address * Phone (work) * Academic rank * Academic Department & Division * Date of first academic appointment at level of Clinical Assistant Professor or higher * Academic Department Head who will be signing off on your application. * For MCS applicants: Academic Dept Head who will be committing the required start-up of $20,000 What is your clinical title/position * In which VCH dept/program do you do most of your clinical work * VCH Clinical Department Head who will be signing off on your appilcation * Which institution pays your salary? * UBC VCH Personal Corporation Other Other (please specify) At which VCH site(s) do you do most of your clinical practice AND research activity Clinical Work: * VGH GF Strong VCH - Community UBC Hospital Richmond Hospital Research: * VGH GF Strong VCH - Community UBC Hospital Richmond Hospital For MCS applicants: Name of your research mentor for this application and his/her department and site What site, building and rooms will you have dedicated research space to conduct your research? * What is your proposed research question or hypothesis? (Maximum of 600 characters) * Keyword 1 * Keyword 2 Keyword 3 Have you read the competition guidelines and do you confirm that you meet ALL eligibility criteria? * Yes No Have you made your clinical dept head, academic dept head, and mentor aware of this registration and their required commitments? * Yes No If any of the above information changes after registration submission, please submit a revised registration form.