Senior Affiliate Application The Canadian Network for Research on Terrorism, Security and Society (TSAS)APPLICATION FOR AFFILIATION FOR SENIOR RESEARCHERS Prof. Dr. Mr. Ms. Name* First Last Professional Title (if applicable) 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 Relevant Publications12345Please share up to five publications. These may be posted on the TSAS website.Publication one. Publication one.Publication two. Publication two.Publication three. Publication three.Publication four. Publication four.Publication five. 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 Select files Max. file size: 1 GB. I would be willing to speak to media about my interests: Yes No If 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.