Senior Affiliate Application The Canadian Network for Research on Terrorism, Security and Society (TSAS)APPLICATION FOR AFFILIATION FOR SENIOR RESEARCHERSProf.Dr.Mr.Ms.Name* First Last Professional Title (if applicable)DepartmentOrganizationOrganization Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country TelephoneFaxEmail* Personal Website Personal TwitterApplication Date Date Format: MM slash DD slash YYYY Select the Research Theme(s) most closely related to your area of interestPrimary area of interest*Terrorism and Violent ExtremismRadicalizationSecurity and CounterterrorismCountering Violent ExtremismSocial Impacts & Consequences of Terrorism and Violent ExtremismSecondary area of interestNoneTerrorism and Violent ExtremismRadicalizationSecurity and CounterterrorismCountering Violent ExtremismSocial Impacts & Consequences of Terrorism and Violent ExtremismRelevant Publications12345Please share up to five publications. These may be posted on the TSAS website.Publication one.Publication two.Publication three.Publication four.Publication five.Attach a copy of your brief CV (e.g. one used for a SSHRC application) 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 I would be willing to speak to media about my interests:YesNoIf yes, list the languages (other than English) that you are able to communicate in:Reporting on Research ActivitiesTSAS requires all affiliates to submit a list of their research activities on April 30th each year. This is a requirement for holding a SSHRC grant and our annual report must be structured using the categories below. TSAS will accept a copy of annual departmental reports submitted to home universities. 1. Funded Research projects 2. Books and research monographs (peer - reviewed): (please include ISBN number and digital link to where publication may be obtained) 3. Books and research monographs (non peer - reviewed) 4. Book chapters (peer-reviewed) 5. Book chapters (non peer-reviewed) 6. Journal articles (peer-reviewed) 7. Journal articles (non peer-reviewed) 8. Other publications 9. Academic conferences/events (proceedings, organizations, papers, etc.) at which you have presented in past year 10. Media engagement (list date, subject, and name of publication, radio/tv station: interviews, op-eds, etc.) 11. Have you attended any TSAS workshops or the Academy to date? a. If so, which ones have you attended? 12. Do you use Twitter? If so, do you follow @TSASNetwork? If you would like TSAS to follow you, please provide your Twitter handle 13. Please provide any 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 Senior Researcher My email address will be added to the TSAS eNews list 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 NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.