Nomination Form

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Become a mentor for a clinical research New Hire Cohort! Mentors will manage a Microsoft Teams channel for their assigned cohort and meet with them as a group bi-weekly (twice a month) for at least 30 minutes. These meetings may consist of a networking activity, discussion of recent challenges, and/or chatting about any questions they have. The mentor will meet with their cohort each month for at least 6 months.

Facilitate (teach) a Session for the RPN+ Foundational Topic Series! We will host an RPN+ session each month that focuses on introductory topics helpful to newer clinical research staff. Topics might include things such as effective communication, collaborating with your PI, and SOP writing. These topics are meant to be taught by Clinical Research staff who perform certain functions well. Do you want to highlight your knowledge in an area that you think would be helpful to new clinical research staff and need leadership experience? Volunteer!

Suggest an RPN+ or RPN Topic! Do you not have a specific nominee in mind but want to suggest a topic for a future RPN+ or RPN session? Suggest a topic that you think would be beneficial to new staff in clinical research!

Are you submitting a mentor nomination for a cohort, to facilitate a RPN+ foundational series session, or simply a suggestion for a RPN+ or RPN topic?

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Mentor for a New Hire Cohort

Facilitate (teach) an RPN+ Foundational Series session

Suggest an RPN+ or RPN topic

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Are you nominating yourself or another staff member?

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Self

Staff Member

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Please provide details about the person you are nominating. If this is yourself, that is fine.

First Name

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Last Name

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Unique ID

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NetID

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Email Address

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Phone Number

Job Title and Tier

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Other, specify

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What Clinical Research Unit (CRU) or Oversight Organization (OO) does the nominee work in?

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What Department or Division does the nominee work in?

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How long has the nominee worked in Clinical Research?

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Brand new to clinical research

< 1 year

1 year - 3 years

>3 years - 5 years

>5 years - 7 years

>7 years or more

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How long has the nominee worked at Duke?

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Brand new to Duke

< 1 year

1 year - 3 years

>3 years - 5 years

>5 years - 7 years

>7 years or more

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What is your relationship to the nominee?

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Direct Supervisor

RPM of CRU or OO

Colleague

Your Name

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Your Email

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What topic would you like to suggest?

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Please include a short description about the topic listed above

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Please upload any materials or additional information you have on the topic described above

Upload file

This topic would be good for:

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New hires

Seasoned staff

Both

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If accepted, does the nominee understand the time committment?

Mentors will probably spend 4-5 hours a month preparing for, scheduling, and attending networking meetings with their cohort.

Facilitators will spend 1 hour leading their RPN session during the month it is scheduled - prep time for your session may vary.

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Yes

Please confirm that the nominee's manager is aware of the nomination of this individual to serve as a mentor or facilitator.

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Yes No

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Manager email

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Please include any comments about why the person and/or topic would be a good fit here.

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