CAPToR Affiliate Faculty Request Form

If you are a current University of Florida faculty member, and would like to be an affiliate faculty member with the Center for Advanced Pain Therapeutics & Research (CAPToR), please complete the steps below.

Full Name(Required)

First

Current Title(Required)

UFID(Required)

UF Email(Required)

Phone(Required)

Primary UF Department(Required)

Campus PO Box #(Required)

Rationale(Required)

Please describe (<400 words) why you are requesting affiliate status with the Center for Advanced Pain Therapeutics & Research (CAPToR).

Please confirm that you've spoken to CAPToR leadership prior to submission:(Required)

I confirm

Please upload the most recent copy of your CV(Required)

CV must include all of your mentoring and teaching activities.

Max. file size: 125 MB.

Signature(Required)

By signing, you agree to the expectations of mentors to hold affiliate faculty status with the Center for Advanced Pain Therapeutics & Research (CAPToR).