Scientific experts database - Registration page 1

From Health Canada

Health Canada utilizes the expertise of qualified scientific experts in support of its review functions and in advisory capacities as part of its scientific advisory panels and committees. In order to generate, screen and maintain an ongoing pool of experts, the Department must collect demographic, educational/scientific qualifications and security information about these individuals. Section 4 of the Department of Health Act provides the authority for the Department to collect this personal information. Only staff within the Department on a need-to-know basis will have access to this information.

Failure to provide all the necessary information to assess the suitability of individuals, may disqualify them from being considered as a potential consultant or as a scientific advisor or member of a scientific advisory panel or committee for the Department. The individual to whom the information pertains has a right of access to, correction of and protection of their personal information under the Privacy Act. This collection is described in a Personal Information Bank named "HC PPU 409 Scientific Review and Evaluation Experts" and registered under number 20110541 in the federal publication Info Source. For further information on any aspect of this privacy notice, please contact Janet Brunette within Health Canada at 613-948-7541.

Session warning

Please note there is a renewable, 30 minute per page time limit to complete your on-line application.
Please print each completed page individually as a copy for your records.
Once you have successfully submitted your application you will get a 'thank you' page with your reference number. If you do not receive this notice you will need to resubmit your information.

Fields marked with * are mandatory.

Areas of service

Please identify which of the four areas of service for which you are responding. You may identify more than one area of service. (required)

Pharmaceutical scientific evaluation

Medical devices scientific evaluation

Reconsideration panels

Scientific advisory committees/scientific advisory panels

I understand that if I am volunteering to provide expert advice as a participant on scientific advisory committees or panels I will receive no monetary compensation however, I understand that accommodation and travel expenses will be paid by Health Canada according to Treasury Board Policy.
Yes (required)

Question 1

Please answer the following:

First name (required)

Last name (required)

Salutation

Mailing address (required)

Business phone (required) ext.

Residence phone

Facsimile

E-mail address (required)

Position/Title

Language capabilities

Emergency contact name

Emergency telephone number ext.

Question 2

Are you a member of a Scientific and/or Medical and/or Technological Research Institute? (required)
Yes No

Are you a member of a Faculty of Science and/or Medicine and/or Technology? (required)
Yes No

If yes, please provide the name and mailing address of your current university/hospital/institution:

Name

Mailing address

Telephone ext.

Facsimile

Application information

Proactive disclosure

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Date modified:: 2017-08-24

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