Form
GLMA Health Trainee Committee Application
HPiT Committee members build LGBTQ+ health advocacy community by serving as a resource for GLMA student and trainee members and empowering others interested in attaining similar accomplishments. HPiT Committee members are selected for a one-year term, from June to June. For a full description, visit this page: https://glma.org/glma_health_professionals_in_t.php. Demographic questions are optional. Please email any questions to: hpitcommittee@glma.org
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First Name
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Last Name
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Credentials
Pronouns
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Email
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Current Degree Program (Please choose all that apply)
Public Health (Masters, Doctorate)
Social Work (Masters, Doctorate)
Psychology (Masters, Doctorate)
Counseling (Masters, Doctorate, LPC, BCC, NCC)
Marriage and Family Therapy (LMFT)
Health Care Administration
Nurse Practitioner (NP)
Nursing (PhD)
Registered Nurse (RN, BSN, ADN)
Physician Assistant/Physician Associate
Pharmacy
Physical Therapy, Occupational Therapy
Medical Doctorate/Doctorate of Osteopathy
Speech-Language Pathology
Art & Expressive Art Therapy (Masters, Doctorate)
Other
Expected Completion Date (Month and Year)
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Educational Institution
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City
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State
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Are you a current member of GLMA? (Not a requirement to apply, but you'll be required to register as a student member if you choose to accept the position)
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Yes
No
Current Group/Organization Memberships
Brief Personal Statement (300 words or less)
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What work have you done in LGBTQ+ health that you believe qualifies you to be a GLMA HPiT Co-chair? Please highlight relevant work, research, volunteer, or advocacy experiences.
Please list skills/interests you would like to share. This can be a short list of areas you feel comfortable advising others or have extensive experience.
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LinkedIn URL
How did you hear about this role?
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Attach your CV/Resume as a PDF
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Confirm that you have capacity to attend monthly recurring meetings
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Yes
No
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Confirm capacity/availability to play a key role in agenda setting and sourcing content for monthly recurring meetings
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Yes
No
Unsure
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