ARCNET Community of Practice Please complete this form to apply to the Academic, Research, and Clinical Network (ARC Network). Fields marked * are required. ARC Network Applicant InformationName(Required) First Last Primary Email(Required)Secondary EmailProvince/Territory(Required)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonGeographic Region (e.g., Northern Ontario)Business PhoneSecondary PhoneRole ClassificationProfessional InformationRole - Select all that apply:(Required) Researcher Academic Clinician Student Policy, program, or practice professional Job Title(Required)Organization / Institution(Required)DepartmentArea(s) of Expertise(Required)Professional WebsiteDiscipline - For clinicians onlyRegulatory Body - For clinicians onlyRegistration Number - For clinicians onlyHighest Degree(s) - For clinicians onlyAssociation Memberships - For clinicians onlyEligibilitySelect all that apply:(Required) I provide mental health treatment and/or assessment I have experience or interest working with PSP I am registered with a regulatory body Experience & ActivitiesCurrent Projects / Activities(Required)Research, Grants, or Funding InvolvementPublic Safety Personnel (PSP) ExperienceNoneLess than 1 year1–3 years3–5 years5+ yearsYears of Experience with PSPDescribe your experience working with Public Safety PersonnelPractice Type: Public Private Both Practice Information (for Clinicians Only) - Service Delivery: In-person Virtual Hybrid Service LanguagesClinic / Organization NamePractice DescriptionSector & Focus AreasSector(s) Healthcare Public Safety Academic Government Non-profit Other Current Activity Areas (Such as research, education, or clinical practice)Terms & ConsentCAPTCHATerms & Consent I have read and agree to the ARCNET Community of Practice Terms of Reference I consent to my information being used for ARCNET Community of Practice purposes such as email I consent to my name appearing in an online membership list. I am interested in sharing my work and would welcome being contacted about presenting at an ARCNET quarterly meeting. ARCNET Community of Practice Terms of Reference .Proposed topics: