Researcher Information Form

Are you currently engaged in research in the field of seniors’ mental health? Would you like to make your name and information available to colleagues and students from across the country? If so, please complete the following form and join our seniors’ mental health researcher database. By completing this form you will have the opportunity to highlight your research interests, past publications and create opportunities for collaboration.

What is Considered Research?

The Seniors’ Mental Health research and knowledge exchange network aims to be all encompassing, focusing on the all aspects of research. Those involved in developing, implementing, transferring, and evaluating research and knowledge related to seniors’ mental health are invited to join the researcher database.

Please note: All data entered in the form will be searchable within the research and knowledge exchange network web site. This is a public access site.

(*Indicates required field)

Login Information
*Email Address:
*Password:
User Information
*First Name:
*Last Name:
*Research Themes: (choose all applicable)	Click for more info on what each theme encompasses Health Services and Policy Mood and Anxiety Disorders Cognitive Disorders and Brain Disease Psychoses Addiction Healthy and Successful Aging Special Populations Pharmacology
*Current Research:
Formal Designation or Position: (choose all applicable)	Assistant Professor Associate Professor Dean Lecturer Professor Professor Emeritus Adjunct Professor Clinical Preceptor Health Care Practitioner Policy/Government/Planning Health Care Administrator/Manager Student
Honours: (chairs, professorships, director, etc)
University Affiliation or Agency Name: (Incl. dept.)
Address:
Phone Number:
Fax Number:
Affiliations and Appointments: (teaching hospitals, research centres, etc)
Web Biography:
Publications of Note:
Other: (comments, questions, invitations for collaboration)