Junior Affiliate Application The Canadian Network for Research on Terrorism, Security and Society (TSAS)APPLICATION FOR AFFILIATION FOR JUNIOR AFFILIATESReason for application Mr. Ms. Dr. Name* First Last Department Organization Organization Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country TelephoneFax Email* Personal Website Personal Twitter Application Date MM slash DD slash YYYY Select the Research Theme(s) most closely related to your area of interestPrimary area of interest* Terrorism and Violent Extremism Radicalization Security and Counterterrorism Countering Violent Extremism Social Impacts & Consequences of Terrorism and Violent Extremism Secondary area of interest None Terrorism and Violent Extremism Radicalization Security and Counterterrorism Countering Violent Extremism Social Impacts & Consequences of Terrorism and Violent Extremism StudentsName of Academic Supervisor(s): Level of Study Masters Doctoral Post-Doctoral Expected Title of Thesis/Dissertation (if applicable): Expected Completion Date: MM slash DD slash YYYY Resume and Statement of RelevanceAttach a copy of your CV and a statement of relevance (250 words max) explaining why you wish to affiliate with TSAS and how your previous work, training, and future plans relate directly to terrorism, security, and society. Drop files here or Select files Max. file size: 1 GB. Reporting on Research ActivitiesTSAS requires all affiliates to submit a list of their research activities on April 30th each year. The following list specifies what you will be asked to submit. 1. Please specify the degree that are you currently completing: 2. Current year of your degree 3. Expected date of graduation 4. Thesis title 5. List any scholarships or awards received: 6. List any academic publications (state if peer or non-peer-reviewed, journal title, issue and date, editors and publisher, digital link) 7. Academic conferences/events at which you have presented at during the period of record 8. Media interviews (list date, name of publication, and provide link if known) 9. List languages spoken: 10. Have you attended any TSAS workshops or the Academy to date? 11. Do you use Twitter? If so, do you follow @TSASNetwork? If you would like TSAS to follow you, please provide your Twitter handle 12. Please provide any other comments relevant to TSASPlease check the following boxes to indicate your understanding and agreement:* I agree to have my name and affiliation will be posted on the TSAS website as a Junior Affiliate My email address will be added to the TSAS eNewsletter I will send an annual report to TSAS for its use in compiling annual reports to SSHRC (see last page for details) I will notify TSAS of any relevant publications and/or conference/workshop presentations I consent to my submitted data being collected and stored EmailThis field is for validation purposes and should be left unchanged.