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Mongan Institute Membership Application

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There are four categories of membership at the Mongan Institute - Core, Affiliate, Trainee/Fellow, and Senior Staff - each with varying degrees of responsibilities and benefits. Applications are required for Core, Affiliate and Trainee/Fellow memberships. Core and Affiliate applicants must have a sponsoring center, mentor, or core faculty member collaborator from the Mongan Institute sign off on their application.

Membership at the Mongan Institute provides resources and benefits for researchers at all stages of their career in addition to those provided by individual Mongan Institute research centers or units. There are two tiers of benefits: Core benefits and Affiliate benefits. While all members have access to Affiliate benefits, access to Core benefits depends on membership category.

All Mongan Institute membership will be renewed annually, dependent on whether member responsibilities are fulfilled in prior year. These renewals and new member applications will be reviewed and approved by the Mongan Institute Leadership Group.

You may review the membership categories, eligibility, and responsibilities on our website: https://www.monganinstitute.org/membership

Any questions can be sent to MGHMonganInstitute@mgh.harvard.edu

We look forward to reviewing your application!

First Name:

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Last Name:

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Credentials:

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Email:

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Phone Number:

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Titles and Institutions:

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Link to Harvard Catalyst (if applicable):

Please describe your ethnicity (select 1):

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Hispanic or Latinx

Not Hispanic or Latinx

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Please describe your race (select all that apply):

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Asian or Asian American

Black or African American

Native American or American Indian

White

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Other

If you selected "Other," please specify:

What is your gender identity?

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Male

Female

Non-binary

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Other

If you selected "Other," please specify:

What Mongan Institute Membership Category are you applying for?

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Core Faculty

Affiliate Faculty

Trainee/Fellow

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Please provide a brief summary of your research interests and explain how they align with research conducted at the Mongan Institute. Please include links to any relevant work. (No more than 1 paragraph)

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Do you have any collaborators or mentors at the Mongan Institute? Please explain your relationship and the research conducted.

* must provide value

Please explain how core membership at the Mongan Institute will benefit your career and research objectives. (No more than 1 paragraph)

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Type your full name below to indicate that you have read the responsibilities expected of Core faculty members and that you agree to uphold responsibilities as a Core faculty member at the Mongan Institute.

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Add signature

Mongan Institute Core Faculty applicants are required to have internal sponsorship. Please download and attach the complete form below.

Attachment:Mongan Institute Membership Sponsorship Form.docx

Attach completed sponsorship form here.

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Upload file

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Do you have any collaborators or mentors at the Mongan Institute? Please explain your relationship and the research conducted.

* must provide value

Please explain how affiliate membership at the Mongan Institute will benefit your career and research objectives. (No more than 1 paragraph)

* must provide value

Type your full name below to indicate that you have read the responsibilities expected of Affiliate faculty members and that you agree to uphold responsibilities as an Affiliate faculty member at the Mongan Institute.

* must provide value

Add signature

Mongan Institute Core Faculty applicants are required to have internal sponsorship. Please download and attach the complete form below.

Attachment:Mongan Institute Membership Sponsorship Form.docx

Attach completed sponsorship form here.

* must provide value

Upload file

* must provide value

Do you have a mentor who is a core or affiliate faculty member at the Mongan Institute? Please explain your relationship and research conducted.

* must provide value

Please explain how trainee/fellow membership at the Mongan Institute will benefit your career and research objectives. (No more than 1 paragraph)

* must provide value

Type your full name below to indicate that you have read the responsibilities expected of Trainees/Fellows and that you agree to uphold responsibilities as a Trainee/Fellow at the Mongan Institute.

* must provide value

Add signature

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