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Many thanks for your interest in becoming a member of the HIV Advisory Body (HAB). As part of this application, you will need to upload your resume and letter of recommendation. Please make sure you have the documents ready when you start this survey. If you do not have a resume, please contact HAB@health.ny.gov to learn about alternative ways of documenting your past experience. 

Please respond to all questions on this survey. If a question does not apply to you, please use N/A. Should you have any questions, please do not hesitate to reach out to HAB@health.ny.gov. 

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* 1. What is your name?

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* 2. What is the name of your organization and your professional title? 

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* 3. If applicable, what is your work address? 

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* 4. What is your home address?

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* 5. What are the best phone numbers to reach you? 

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* 6. Please input your primary and secondary email addresses: 

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* 7. What is your preferred method of contact?

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* 8. What is your preferred mailing address?

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* 9. What is your county/borough of primary residence?

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* 10. Which of the below regions will you be representing? 

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* 11. Please upload your resume*.

*If you do not have a resume, please notify your staff via contact HAB@health.ny.gov.

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* 12. Please upload your letter of recommendation. 

PDF, DOC, DOCX file types only.
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