SIRC Trainee Network of Expertise (NoE) Application
Thank you for your interest in the SIRC Trainee NoE! We are excited that you are interested in joining our network of dedicated members sharing a mutual passion for dissemination and implementation work. Please fill out the application below.

The Trainee NoE is comprised of undergraduate students, post-baccalaureates, graduate students, and post-doctoral fellows who either (1) have experience in dissemination and implementation (D&I) and are interested in being a peer resource to SIRC student/trainee members and/or (2) are interested in assisting with SIRC's initiatives for trainees.

Successful applicants will have a clearly demonstrated commitment to D&I and willingness to participate in the NoE as an active member. Furthermore, the information provided in this application will be extremely helpful for identifying mentorship matches and supporting general networking among SIRC members.
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Please send your CV to sircimplementation@gmail.com with "CV for NoE Application" in the subject line.
Name: *
Website profile (e.g., personal website, lab website, school website, ResearchGate):
Career Stage: *
Program Type and Degree (e.g., Social Work MA, Clinical Psychology PhD, Health Policy and Management PhD): *
University/Program Affiliation(s) (e.g. UCLA, Kaiser Permanente): *
Please enter 3 – 5 keywords that will help others understand your expertise. Please consider: 1) General area(s) of interest (e.g., behavioral health, addictions, health, education, human services, etc.), 2) Implementation area(s) of interest (e.g., mechanisms, sustainability, fidelity, adaptation, scale-up, de-implementation, dissemination, adoption, direct-to-consumer, policy, UCD, DMH, learning collaboratives, consultation, system redesign, etc.), and 3) Sub-population/group(s) of interest (e.g., veterans, children, LMICs, etc.): *
Twitter handle (e.g., @ClaraJohnson_)
Email: *
Name of Research Advisor/Mentor (if applicable): *
Have you secured any dissemination & implementation-related funding (e.g. grants, awards, fellowships, both pre-and postdoctoral)? If yes, please write which grants. *
We post NoE member's name, website, career stage, program type, university/program affiliation, research interests, and twitter handle to the SIRC website. Do you consent to having this information shared? If not, please note what information you do not want shared on the SIRC website. *
How has dissemination and implementation influenced your thinking about research to date? *
Which initiatives are you willing to participate in as an active member of the Trainee NoE (check all that apply)? *
Required
Which mentorship models would you be willing to provide? *
Yes
No
Individual peer mentorship
Group mentorship meeting(s)
Hosting Office Hours on a specific topic
How frequently are you willing to provide mentorship? *
Yes
No
One-time consultation
Weekly
Monthly
Quarterly
What are your interests in research, clinical, and/or D&I practice? Please respond with information to help us make mentorship matches. *
What are you specifically able to provide mentorship on? Possible examples include: general mentorship (e.g., long-term career planning, prioritizing projects); research collaboration opportunities; learning more about D&I; grant writing; workshopping an idea; dissertation execution mentorship on. *
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