Health Equity Experts Network Application We are pleased to invite you to join the Health Equity Experts Network. Please complete this brief form to submit your application to the Network.Profile InformationName and Degrees*Title*Organization*Organization Website City and State* City State / Province / Region Work Phone*Cell PhoneEmail* Profile PhotoPlease upload a photo for use on your Experts profile. It should be of good quality, but please note the maximum file size for uploading is 1MB.Accepted file types: jpg, gif, png.TwitterLinkedInAssistant's Name First Last Assistant's PhoneAssistant's Email Availability for Other Activities*In addition to participating in media interviews, please indicate whether you would be interested in participating in the following activities: Op-Ed Greenhouse (a free thought leadership and coaching program, includes three 1-2 day training sessions in Washington, DC) Health Equity Strategy Summits Policy Briefings or Public Events in Washington, DC Advising Organizations (e.g. how to design equitable programs or policy strategies in your area of expertise) Webinar Presenter Developing Training Curricula None of These ExpertiseAreas of Expertise*Please indicate whether you have expertise in one or more of the following social determinants of health (select all that apply): Built Environment Community Power Criminal Justice Education Environmental Quality Food Access Health Care Access and Quality Housing Income Security Social Environment Systemic Oppression Transportation Populations*Please indicate whether you have expertise with one or more of the following populations (select all that apply): African American American Indian/Alaska Native Asian/Pacific Islander Children and Youth Latino LGBTQ Low-Income Rural Communities Seniors Urban Communities Women Biographical Text*The bio provided here will be used for your profile on the ARCHE website. Please note that a media-friendly bio is short enough (maximum 400 words) for a media booker to quickly scan. Your bio should lead with your position and include the following key items: • Relevant work experience • Sub-specialty expertise • Specific achievements/experiences that qualify you to speak with authority in your area of expertise • Graduate degrees • Books you have written • Top media appearances (e.g. CNN, NPR, Baltimore Sun) Submitted bios may undergo minor copy editing as part of content review and quality control processes for the ARCHE website. Articles/Books/PublicationsPlease provide us with information about your most relevant media citations. These will be included in your online Network profile. Click the plus button below each listing to add additional citations.Type of CitationPlease select the option that best describes your role in this media piece.AuthorQuotedCitedArticle TitleArticle Link URL Author Name(s)Publication NamePublication Date VideosPlease provide us with links to any videos that feature your expertise. These will be included in your online Network profile. Click the plus button below each listing to add additional videos.Video TitleVideo Source URLThe original page where the video is published Video Source NameThe video source organization, e.g. CNN or NBC News Demographic InformationEnsuring diversity and inclusion is at the core of the work we do at ARCHE. Please help us track and asses the diversity of the Network by providing your demographic information. This data will be kept confidential.Racial/Ethnic Background*Which of the following best describes your racial and/or ethnic background? (select all that apply) African American or Black American Indian or Alaskan Native Arab or Middle Eastern Asian or Pacific Islander Latino or Hispanic White or Caucasian Biracial Other (please specify) Other Racial/Ethnic BackgroundWhat is Your Age?*18-24 years25-34 years35-44 years45-54 years55-64 years65 or olderPersonal Immigration Experience*Which of the following best describes your personal immigration experience?First-generation: I was born outside the United States or U.S. territories.Second-generation: I was born in the U.S. with at least one immigrant parent.Third-generation or higher: my parents are/were born in the U.S.Gender Identity*With which gender identity do you most identify?FemaleMaleNon-binary/third genderPrefer not to saySexual OrientationWhich of the following best describes your sexual orientation?Lesbian, Gay or BisexualStraight or HeterosexualPrefer Not to SayDo you identify as Transgender?YesNoPrefer Not to SayRegional InformationIn what region of the country do you live?Northeast Region (New England Division: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont; Middle Atlantic Division: New Jersey, New York and Pennsylvania)Midwest Region (East North Central Division: Illinois, Indiana, Michigan, Ohio and Wisconsin; West North Central Division: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota)South Region (South Atlantic Division: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia and West Virginia; East South Central Division: Alabama, Kentucky, Mississippi and Tennessee; West South Central Division: Arkansas, Louisiana, Oklahoma and Texas)West Region (Mountain Division: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah and Wyoming; Pacific Division: Alaska, California, Hawaii, Oregon and Washington)CAPTCHA
We are pleased to invite you to join the Health Equity Experts Network. Please complete this brief form to submit your application to the Network.Profile InformationName and Degrees*Title*Organization*Organization Website City and State* City State / Province / Region Work Phone*Cell PhoneEmail* Profile PhotoPlease upload a photo for use on your Experts profile. It should be of good quality, but please note the maximum file size for uploading is 1MB.Accepted file types: jpg, gif, png.TwitterLinkedInAssistant's Name First Last Assistant's PhoneAssistant's Email Availability for Other Activities*In addition to participating in media interviews, please indicate whether you would be interested in participating in the following activities: Op-Ed Greenhouse (a free thought leadership and coaching program, includes three 1-2 day training sessions in Washington, DC) Health Equity Strategy Summits Policy Briefings or Public Events in Washington, DC Advising Organizations (e.g. how to design equitable programs or policy strategies in your area of expertise) Webinar Presenter Developing Training Curricula None of These ExpertiseAreas of Expertise*Please indicate whether you have expertise in one or more of the following social determinants of health (select all that apply): Built Environment Community Power Criminal Justice Education Environmental Quality Food Access Health Care Access and Quality Housing Income Security Social Environment Systemic Oppression Transportation Populations*Please indicate whether you have expertise with one or more of the following populations (select all that apply): African American American Indian/Alaska Native Asian/Pacific Islander Children and Youth Latino LGBTQ Low-Income Rural Communities Seniors Urban Communities Women Biographical Text*The bio provided here will be used for your profile on the ARCHE website. Please note that a media-friendly bio is short enough (maximum 400 words) for a media booker to quickly scan. Your bio should lead with your position and include the following key items: • Relevant work experience • Sub-specialty expertise • Specific achievements/experiences that qualify you to speak with authority in your area of expertise • Graduate degrees • Books you have written • Top media appearances (e.g. CNN, NPR, Baltimore Sun) Submitted bios may undergo minor copy editing as part of content review and quality control processes for the ARCHE website. Articles/Books/PublicationsPlease provide us with information about your most relevant media citations. These will be included in your online Network profile. Click the plus button below each listing to add additional citations.Type of CitationPlease select the option that best describes your role in this media piece.AuthorQuotedCitedArticle TitleArticle Link URL Author Name(s)Publication NamePublication Date VideosPlease provide us with links to any videos that feature your expertise. These will be included in your online Network profile. Click the plus button below each listing to add additional videos.Video TitleVideo Source URLThe original page where the video is published Video Source NameThe video source organization, e.g. CNN or NBC News Demographic InformationEnsuring diversity and inclusion is at the core of the work we do at ARCHE. Please help us track and asses the diversity of the Network by providing your demographic information. This data will be kept confidential.Racial/Ethnic Background*Which of the following best describes your racial and/or ethnic background? (select all that apply) African American or Black American Indian or Alaskan Native Arab or Middle Eastern Asian or Pacific Islander Latino or Hispanic White or Caucasian Biracial Other (please specify) Other Racial/Ethnic BackgroundWhat is Your Age?*18-24 years25-34 years35-44 years45-54 years55-64 years65 or olderPersonal Immigration Experience*Which of the following best describes your personal immigration experience?First-generation: I was born outside the United States or U.S. territories.Second-generation: I was born in the U.S. with at least one immigrant parent.Third-generation or higher: my parents are/were born in the U.S.Gender Identity*With which gender identity do you most identify?FemaleMaleNon-binary/third genderPrefer not to saySexual OrientationWhich of the following best describes your sexual orientation?Lesbian, Gay or BisexualStraight or HeterosexualPrefer Not to SayDo you identify as Transgender?YesNoPrefer Not to SayRegional InformationIn what region of the country do you live?Northeast Region (New England Division: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont; Middle Atlantic Division: New Jersey, New York and Pennsylvania)Midwest Region (East North Central Division: Illinois, Indiana, Michigan, Ohio and Wisconsin; West North Central Division: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota)South Region (South Atlantic Division: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia and West Virginia; East South Central Division: Alabama, Kentucky, Mississippi and Tennessee; West South Central Division: Arkansas, Louisiana, Oklahoma and Texas)West Region (Mountain Division: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah and Wyoming; Pacific Division: Alaska, California, Hawaii, Oregon and Washington)CAPTCHA
