Stem Cell Oversight Committee (SCOC)
Applicant/Nominee's Informed Consent Form
The Canadian Institutes of Health Research (CIHR) nomination process has been designed to respect Canada's laws regarding privacy. As a result, CIHR is required to seek permission from candidates for permission to collect personal information relating to their suitability for membership on the Stem Cell Oversight Committee (SCOC). A nominator putting forth an individual as a candidate for membership on the Stem Cell Oversight Committee is required to confirm the nominee's consent in writing before submitting any personal information on the nominee.
To confirm your consent, you must complete and sign this form. You or the nominator must then send it by mail or courier (along with the rest of the application package) to:
Barbara Beckett
Canadian Institutes of Health Research
410 Laurier St. West, 9th Floor
Address Locator 4209A
Ottawa, Ontario K1A 0W9
If you have any questions, call CIHR at (613) 941-2672 or 1-888-603-4178 or e-mail stemcell@cihr-irsc.gc.ca
This form is required as part of the complete application, and must be submitted at the same time as the rest of the application or nomination. Applications will not be considered without the consent form.
The information is being collected for the purpose of providing information on the qualifications of candidates being considered for membership on the Stem Cell Oversight Committee. Your consent to release this information will enable CIHR to have access to the information submitted by you or others and to retain your personal information in its files for two years from the deadline date for the receipt of applications for the SCOC. This information will be stored in Personal Information Bank number CIHR PPU 020. Personal information gathered from the application/nomination form is protected under the provisions of the federal Privacy Act (R.S.C. c.P-21).
I, ________________________________________________(Please print clearly name of applicant or nominee),
hereby do consent to have ____________________________________________(Name of nominator if applicable) nominate me for
membership on the Stem Cell Oversight Committee.
I also consent to the collection by CIHR of personal information about me for the purpose of providing information regarding my qualifications for Stem Cell Oversight Committee membership.
Signed : _____________________________________________
Date : ________________________
City : _____________________________________
