2026 Student Membership Application
Application Deadline: Friday, March 27, 2026
Applicant Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
School
*
Area of Study
*
Degree in pursuit
*
Expected Graduation Date
*
How did you hear about The HAVI
*
Describe any interactions with a hospital-based violence intervention program. Including name of program and dates you were involved with the program.
*
Describe any previous interactions with The HAVI. Including trainings, webinars, workgroups or conferences attended. Please list dates if applicable.
*
Why do you want to be a member with The HAVI?
*
What skills/expertise do you bring to The HAVI network?
*
**Applicants will be contacted by HAVI staff for virtual meeting.
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