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Register for “The Messenger Chronicles”
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First Name*
Last Name*
Position/Title*
Location / State*
New York City
New York State except New York City
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Outside of the United States
Other State [Please Select]
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AR
CA
CO
CT
DE
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ID
IL
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MI
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MS
MO
MT
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OK
OR
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TX
UT
VT
VA
WA
WV
WI
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Years in current occupation*
Less than 6 months
6 months to 2 years
2 to 5 years
More than 5 years
Are you taking this course as part of required training? *
No
Yes, undergraduate program
Yes, graduate program
Yes, public health agency training
Yes, other agency training
Please enter the name of the requiring institution/agency
All HRSA-funded public health training centers are required to report the information requested in the following questions.
Sex*
Female
Male
Race / ethnicity*
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other
Age group*
Under 20
20-29
30-39
40-49
50-59
60 or older
Work Discipline*
Public Health
Other (indicate below)
Other Work Discipline
Practice area within public health*
Biostatistics
Environmental health
Epidemiology
Full-time student
Health administration
Health education
Health officer
Health planner
Public health nursing
Other (indicate below)
Other Practice Area
Primary Work Setting*
County Health Department
Local Health Department
State Health Department
Other State Agency
Hospital
Long-term Care Facility
Other Health Care Facility
Private Medical Practice
College/University
Business/Industry
Not-for-Profit
Other (indicate below)
Other Primary Work Setting
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