BCPH Academy Faculty Form
Name
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First Name
Last Name
Email
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example@example.com
Pronouns
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Example: She/Her/Hers
Country of Residence
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Country of Origin
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Title
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MD/DO
ScD/SD/DSc
PhD
JD
MA
MS/MPH
Multiple Degrees
In process degree
Brief Bio (4-5 lines) (Do not use bullet points. Must be in narrative style.)
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Upload CV
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Upload Professional Headshot
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Tell us about your proposed course or courses. Please include title as well as outlines sub-topics.
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Proposed area of public health and social justice for course(s)
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Health policy
Health management
Maternal and Child Health
Reproductive and sexual health
LGBTQ+ Health
Men's Health
Women's Health
Substance Use, Abuse, and Addiction
Refugee/Immigrant Health
Infectious diseases
Environmental health
Occupational health
Dental Health
Global Health
Disability
Public Health Entrepreneurship
Public Health Leadership
Research
Surgery/Global Surgery
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Proposed areas for pre-medical academy
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The Metaverse and Healthcare
Medical Assistance with Dying
All the "omics" of medical research
Palliative Sedation
Organ Transplantation
Brain Death and Cardiac Death: Protocols and Procedures
Telemedicine
Personalized Medicine
Global Health
Diversity and Equity in Healthcare
Physician Decision Making for Incapacitated Patients
Medical Tourism
NA
Demographics
Below are some background questions that help us tailor our programming. You are not obligated to answer.
Gender: I identify as (click all that apply):
Man
Woman
Non-Binary
Trans gender
X
Race: I identify as (click all that apply):
White
Black or African American
Asian
American Indian and Alaska Native
Native Hawaiian and Other Pacific Islander
Please verify that you are human
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Today's Date: I understand that my submitting this form, I agree that I will produce a course(s) and intend to give it IN-PERSON at one or more of the sessions.
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Day
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Month
Year
Date
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