Section 1 of 6: Basic Information

This form is for individuals who want to sign up for our COVID-19 & Higher Education program mailing list. To learn more about the AAPD COVID-19 & Higher Education Program, please view our website. Please note: To be included on our mailing list, sign-up must be submitted via Survey Monkey. If you are having any difficulties with accessibility in the Survey Monkey, please don’t hesitate to contact us or download and email a completed Word version of this form to: Education@aapd.com.

Optional:
We also invite you to share more information about yourself and how you’d like to get involved with the AAPD COVID-19 & Higher Education Advocacy Program. We also encourage people who are impacted by COVID-19 and systemic challenges in higher education to share more about their work on this form.


The information collected here will be used to inform how AAPD will create multiple modalities and means for community members to participate and collectively organize. This may include focus groups for specific topics or communities, opportunities to join our Discord Server (or other platform) in its pre-release testing phase, and invitations to provide feedback as we work to develop our program.

Question Title

* 1. What is your email?

Question Title

* 2. What is your first name?

Question Title

* 3. What is your last name?

Question Title

* 4. Would you like to share more information about yourself? (This includes but is not limited to: sharing your story, share additional demographic information and/or provide any additional feedback)

T