VCU Massey Cancer Center

Biographical data entry form for clinicians and researchers who work with cancer

Massey is preparing to re-launch the “Find a cancer expert” directory on our Web site. If you work with cancer as a researcher or clinician, you belong in this directory. Even if cancer is only one of multiple diseases you treat or study, you belong. Nurses, nurse practitioners and research nurses belong in this directory.

The first field below requires that you enter your VCU eID. If you do not know your eID or if you have questions and/or problems, please check out the VCU eID FAQ page or contact VCU Help Desk at (804) 828-2227. If you hold an affiliate appointment with VCU and do not have an eID, please contact David Raine for additional instructions.

Please fill out and submit this form today. E-mail David Raine or phone (804) 628-1829 if you have any questions.

*Required

VCU eID*
Last name*
First name*
Middle name
Suffix (Jr., III, etc.)
Full name as you wish it displayed w/degrees*
Faculty rank (if applicable)
Primary department
Division within primary department
Secondary department affiliation
Additional department affiliations
Clinical specialty
Research program
Campus Post Office Box number
Appointment telephone number
Office telephone number
Fax number
Pager number
E-mail address*
Web page URL (if applicable)
Research “key words”: Help others find you by providing search terms, including research focus, types of cancers you study and areas of specialization.
Research expertise – Please write a short paragraph describing the research you do.
Clinical “key words”: Help others find you by providing search terms, including clinical focus, types of cancers you treat and areas of specialization.
Clinical expertise – Please write a short paragraph describing your clinical practice or expertise.
All Massey multi-disciplinary teams with which you are affiliated
All Clinic locations where you see patients
(Massey Flagship, Stony Point, Hanover, McGuire VA, Rural Cancer Outreach)
Degree – 1
Degree – 1, institution awarding degree
Degree – 1, year degree awarded
Degree – 2
Degree – 2, institution awarding degree
Degree – 2, year degree awarded
Degree – 3
Degree – 3, institution awarding degree
Degree – 3, year degree awarded
Residency hospital – 1
Residency hospital – 2
Fellowship or other significant appointment

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