Expression of Interest Survey: Participating in the Health Equity Adaptive Mentorship Network

Thank you for your interest in participating in the Equity in Health System (EqHS) Lab's Health Equity Adaptive Mentorship Network. Through this survey we hope to understand a little about you, your background and why you would like to be involved in this Network.

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* Contact Information

Last Name: *

First Name: *

Contact Email Address: *

Contact Telephone Number:

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* Which region are you based in?

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* Why are you interested in being part of this network? What are you hoping to get out of this opportunity?

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* How did you hear about us?

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* Would you like to provide any other information?