Community Health Information Form
Community Health Information Form
Please complete the form below if you are interested in being part of a Community Health Consortium.
Name
Name
*
Title
First
Last
Suffix
Institution
*
Email
*
Which area of Community Health best captures your work/interests? (Check all that apply)
*
Which area of Community Health best captures your work/interests? (Check all that apply)
Diabetes
Substance Abuse Disorders
Childhood Obesity
Mental Health
Food Insecurity
Housing Stability
Transportation
COVID Impact
Other
Other
If you have a recent project or idea that you would like to share with a group focused on community health, briefly describe it below:
In addition to your own research if you are interested in working on collaborative community health projects, what roles interest you?
*
In addition to your own research if you are interested in working on collaborative community health projects, what roles interest you?
Program design
Evaluation
Communication
Implementation