ARC Network form application ARC Network Applicant InformationFirst Name(Required)Last Name(Required)Primary Email(Required)Secondary EmailProvince/Territory(Required)Geographic Region (e.g., Northern Ontario)Business PhoneSecondary PhoneRole ClassificationRole – Select all that apply:(Required) Researcher Academic Clinician Student Professional InformationJob 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 & ConsentTerms & 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 .
