ARC East Midlands Faculty Membership Please provide as much information as you can. However do not be put off by lack of previous research experience – it is your ideas and commitment we want. Title * Name First Name * Last Name * Email * Phone * Partner organisation * Position in organisation * Areas of interest in ARC EM * You may select more than one option. Building Community Resilience and Enabling Independence Data2Health Ethnicity and Health Inequalities Managing Multimorbidity Mental Health and Wellbeing Translating and Implementing Sustainable Service Improvement Why do you want to become part of ARC EM? * How can you support ARC EM? * For example, provide mentorship, implementation support, expert speaker at events or training, become an interview panel member for postgraduate or postdoctoral recruitment. Any other comments or additional information in support of your application * Please upload your CV in support of your application * Files must be less than 2 MB.Allowed file types: rtf pdf doc docx odt ppt pptx odp xls xlsx ods. Data Protection In submitting your information you consent to ARC EM processing your data for the purpose of considering your application as a Faculty Member and if your application is successful your details will be retained so that you can be notified of Faculty-related activities. Your information will be kept by ARC EM until 30th September 2024, which is the current end date for funding for ARC EM. At the end of ARC EM your information will be deleted from ARC EM’s and its partners’ databases and systems in accordance with the Data Protection Act 1998. Please tick the relevant box depending on whether you do, or do not consent to your information being used in the manner detailed above. Consent * I consent I do not consent If you consent, you will receive notification of the outcome of your application within 10 working days. For more information contact firstname.lastname@example.org.