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* 1. Contact Information

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* 2. What Faculty do you belong to?

 
University of Alberta Faculties

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* 3. Please indicate which research role best describes you as it relates to your research and/or education interests in neuroscience, mental health and addiction.

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* 4. Are you currently a member of any of the following University of Alberta research units, groups, or centres? Please check all that apply.

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* 5. Which CIHR health research pillar/theme best describes the type of research that you perform? Please choose all that apply.

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* 6. Please choose those disciplinary fields that describe your expertise. Please choose all that apply:

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* 7. As it relates to the proposed institute, what area does your research fall under? Please choose all that apply.

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* 8. If you were applying for a translational research grant, what disease entities and/or disorders does your research relate to, either directly or indirectly? To answer this question, please list up to 4 such diseases and/or disorders under the following applicable areas:

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* 9. Please provide several bullet points describing your research interests.

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* 10. Please list key approaches, techniques, and/or platforms that you use in your research. For example: genetic epidemiology, pharmacogenomics, electrophysiology, neuroimaging, machine learning, functional magnetic resonance imaging (fMRI), etc:

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* 11. Are there research capabilities (infrastructures, cores, equipment, databases, etc) that would enhance your research program if you had access to such? Please describe, if applicable.

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* 12. Please describe your clinical trial interests (if applicable). Choose all that apply.

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* 13. Please list the individuals with whom you collaborate, including their institution (please cite local, national, and international collaborators):

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* 14. Please indicate those activities that you would be interested in engaging in as a member of the institute. Choose all that apply.

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* 15. What are your expectations of a neuroscience and mental health institute?

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* 16. Please provide additional comments that you wish to share:

Thank you for taking the time to complete this survey.

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