NC NM4R March 2020 taVNS Workshop Application

To be considered for attendance, please provide us with some further information about yourself. All applicants must first be members of the NC NM4R community for consideration.

Please note:

This workshop will be recorded and made available online. All in-person participants will be required to sign an image release form allowing the use of your likeness for this purpose.

Due to our funding by United States Department of Health and Human Services, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health & Human Development under award number P2CHD086844, we must restrict admission to the workshops to those applicants who are affiliated with US-based institutions and who are eligible to receive NIH funding.

In-person attendance is now closed. Please click here to acknowledge you will be attending online via videoconference. We will follow up via email with conferencing details once they become available.

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I will attend via videoconference.

First Name

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Last Name

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Please tell us the academic credentials/degrees you have attained (e.g., M.D., Ph.D., PT, OT, etc.).

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Please tell us the academic ranks/titles you have attained (e.g., Assistant Professor, Investigator, Lead Lab Technologist, etc.).

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Please list your current institutional and departmental affiliation(s).

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Please select the state in which the primary institution with which you are affiliated is located.

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Please tell us a little about your background in neuromodulation for rehabilitation.

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What experience or training have you had in neuromodulation?

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How do you plan to apply training from the NCNM4R in your work? Please include description of any planned research grant submissions.

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If attending in person, would you like to present a poster on your work at the workshop?

Yes

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If so, please upload an abstract of your presentation.

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If attending in person, please let us know about any dietary restrictions you may have or any other accommodations you may require.

A brief CV or biosketch is required for workshop registration.

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