The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

k5qIWaYKze6B3kYLEy86IDkQAQjATc3eSAyKdsVUbBUtMhvnJZusgxRVvhxYLRaK

PHDR Membership Registration

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Thank you for your interest in working with us towards eliminating health inequalities. Since the Program in Health Disparities Research (PHDR) started in 2006, our community and academic initiatives, collaborations, and research have grown. As a member, you will join other members from diverse communities and academic backgrounds. The program's success is largely contributed by our members. More information about membership can be found here at https://z.umn.edu/PHDRmembershipapp.

Please take a few minutes to complete the following survey. If you have any questions in the meantime, please email phdr@umn.edu.

Last Name

* must provide value

First Name

* must provide value

Middle Initial

Degree(s)/Experience:

What is your current affiliation?

UMN Faculty

Community member

Trainee/ Student

UMN Staff

Non-UMN

Other

Please specify.

If UMN faculty, what is your title?

Professor

Associate Professor

Assistant Professor

Other

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If other, please specify:

If UMN faculty, in which division/department and/or school is your appointment held?

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If community member, what is your title?

Community health worker

Program manager/ director

Administrative professional

Project coordinator

Other

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If "other," please specify:

If community member, what group or organization are you affiliated with?

* must provide value

If trainee/ student, what is your anticipated degree, program, and school?

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If UMN staff, please specify:

Research Staff

Coordinator

Administrative Support

Department Staff

Other

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Please specify.

If UMN staff, in which division/department/program/center is your primary position held?

* must provide value

Phone:

Which phone number have you provided?

E-mail:

* must provide value

Address line 1:

Address line 2:

City:

* must provide value

State:

* must provide value

Zip Code:

Which address have you provided?

Please select the topics you are interested in.

* must provide value

Racial/ ethnic minorities

Immigrant/ refugee

Sexual minority

Rural populations

Low socioeconomic status

Obese/ overweight people

Social determinants on health

Mental health/ addiction

Racism

Behavior health

Diabetes

Child/ adolescent

Education

Health Policy

Other

N/A

Please specify.

Briefly state your current specific area of research interest or expertise.

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Do you have any experience working with community organizations?

Yes No

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Please list the organizations.

Would you like to be considered as a possible presenter on a relevant health disparities topic at our monthly Health Equity Seminar Series? You will not be scheduled without being asked first and do not need to have a topic in mind.

Yes No

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How did you hear about PHDR?

University of Minnesota faculty/ staff member

Website

E-mail Listserv

Event

Other

If other, please specify:

Please leave any comments or suggestions for the Program in Health Disparities Research here.

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