Scientific Review Panel Application Form

Please complete this form to express your interest in joining Branch Out’s Scientific Review Panel for future grant application processes. 

Personal information and Research Expertise


This information will be used to help match your expertise with applications and send you tokens of gratitude for your service on our Scientific Review Panel.
Expertise
The following sections are used to match grant applications with your areas of expertise.

Substantive Research Experience
Please list topic areas of your research expertise that you could evaluate applications on (e.g. depression, neuroplasticity, etc.)

Methodological Research Experience
Please list any research methodologies that you have experience with and could evaluate applications on (e.g. microscopy, machine learning, neuroimaging, etc.)

Clinical Experience
Please list any relevant clinical experience that could help you evaluate more clinically orientated applications
Confidentiality and Intellectual Property Paragraphs:

By submitting this Branch Out Scientific Review Panel Application and Information Form (the “Application”), you agree to maintain any and all information disclosed, directly or indirectly, to you as a result of the Application, including, but not limited to, all documents or materials relating to the Grant Application(s); all evidence or records relating to the Grant(s); all technical and scientific information, data, materials, knowledge, know-how, methods, techniques, skill, formulations, software, results, research and development, and trade secrets; all marketing, commercial, sales, and distribution information; and all financial and business information, initiatives and opportunities (the “Confidential Information”) in the strictest confidence. You further agree to use the Confidential Information solely for the limited purpose of performing the Grant Application review(s).

By submitting this Application, you further agree to maintain any and all proprietary information, knowledge, know-how, techniques, processes, procedures, research and development, and trade-secrets; technology, materials, products, designs, results, software, data, formulae and algorithms; discoveries, developments, inventions, and improvements; all patent applications, patents, trade-marks, trade dress, copyrights and moral rights, industrial designs, semiconductor chip designs, and integrated circuit topography; and other intellectual property rights that arise from, or are conceived, created, developed, or improved whether or not reduced to practice, as a result of the Grant Application(s) (the “Intellectual Property”) in the strictest confidence. You further agree to use the Intellectual Property solely for the limited purpose of performing the Grant Application review(s).

By submitting this Application, you agree that you have no right, title, or interest in the Intellectual Property or the Confidential Information as a result of your submission of the Application and your review of the Grant Application(s).

Conflict of Interest Paragraph:

By submitting this Application, you agree that you shall not review any Grant Application(s) where a conflict of interest exists between you and any party involved in the Grant Application(s), including but not limited to conduct involving the acceptance of favours or financial benefits, being employed, engaged in a current supervisor or other collaborative relationship, or engaged in any capacity resulting in a conflict of interest with a party to the Grant Application(s), or being engaged in public activities that result in a conflict of interest with a party to the Grant Application(s). Should you become aware of a conflict of interest, you agree to immediately advise the Branch Out Neurological Foundation of the conflict and to undertake to resolve the conflict. If you are in doubt regarding a potential conflict of interest, you should consult the Branch Out Neurological Foundation for direction. If the conflict of interest cannot be resolved, you agree to withdraw from the review of the applicable Grant Application(s).