Clone of Morgan State University Community Conversations Registration Form

COGI Community Conversations

Lincoln University of Missouri - March 2, 2026 PLEASE NOTE: You must be a currently enrolled LU student or faculty member to attend this event.
Full Name:*

First NameLast Name
City/State You're From*
Email Address*
example@example.com
Major or Staff Position:*
What School are you studying under?*

School of MedicineSchool of BusinessSchool of Liberal ArtsSchool of ScienceSchool PharmacySchool of NursingFaculty MemberOther
What year of school are you in?*

Freshman YearSophmore YearJunior YearSenior YearNot Applicable
What gender do you identify as?*

FemaleMaleNon-BinaryPrefer Not To Answer
What is your Ethnicity?*

African AmericanHispanicNative American or Other Pacific IslanderMulti-EthnicAmerican IndianAsianCaucasian
What is your age range?*

17-2122-2526-30Other
Have you ever attended a digestive health event at your university?*

Yes, I haveNo, I have not
Do you know what a Chronic Illness Is?*

YesNo
Do you experience any recurring stomach pain, bloody stool, or any other gastrointestinal symptoms?*

YesNo
Have you been diagnosed with any of the digestive illnesses listed below? Please select the options that apply.*

IBD (Crohn's or Ulcerative Colitis)IBS (Irritable Bowel Syndrome)NeitherOther
If you've been diagnosed with a different digestive illness and feel comfortable sharing, please list below:
Do you know someone (immediate family or close circle) with Inflammatory Bowel Disease (IBD)?*

YesNo
Does anyone in your immediate family suffer from any other chronic disease? (heart disease, cancer, diabetes, etc.)*

Irritable Bowel Syndrome (IBS)Heart DiseaseCancerDiabetesMultiple Chronic DiseasesNoneOther
Do you struggle with your mental health?*

YesNo
Clinical Research Opportunities (please check all that apply)*

I have participated in a clinical research study.I have never participated in a clinical research study.I have never been asked to participate in any clinical research study opportunities.I am interested in learning more about clinical research study opportunities.
By registering for COGI's Community Conversations I also pledge to:
- Have open conversations with family and friends about digestive health and preventative healthcare.
- Be a personal health advocate for my family by providing them with education and resources.
- Be aware of my own health and seek medical care when symptoms arise.
- Encourage family and friends to seek medical care when symptoms present and advocate for themselves.
As a registrant of Community Conversations, I herby authorize COGI to use my photo, voice, and video likeness in any manner they may elect, using any and all media known or hereafter devised. NOTE: Clicking "Register" means you agree to COGI's Photo Release Policy and protocols.*

Agree
Should be Empty:

COGI Community Conversations