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Identities within the Harvard research community
Your first name:
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Your last name:
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Your email:
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Your current affiliation:
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Beth Israel Deaconess Medical Center
Boston Children's Hospital
Brigham and Women's Hospital
Broad Institute
Cambridge Health Alliance
Dana Farber Cancer Institute
Fenway Institute
Forsyth Institute
Harvard Medical School
Harvard Pilgrim Health Care Institute
Harvard T.H. Chan School of Public Health
Harvard University
Mass General Hospital
Ragon Institute of MGH, MIT and Harvard
Wyss Institute
Other (Please specify)
Other (Please specify)
Are you involved in HIV/AIDS research?
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Yes
Not currently but I am interested
Other
Other
Briefly describe your HIV/AIDS research
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What is your current role/position within your institution?
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Undergraduate student
Graduate student
Postdoctoral fellow/researcher
Faculty
Research Technician/Assistant
Other
Other
Your PI's first and last names
Your PI's email
I wish to join the HU CFAR DEI Working Group:
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Yes
No
I am already part of the DEI Working Group
Unsure (please explain the reason/s)
Unsure (please explain the reason/s)
Why do you wish to join the HU CFAR DEI group?
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I am part of an underrepresented group and wish to do HIV/AIDS research
I am NOT part of an underrepresented group and wish to forward the DEI mission
Other
Other
Demographic Information
Gender
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Genderqueer
Transgender female
Transgender male
Non-Binary
Cisgender female
Cisgender male
Prefer not to respond
Self-identification / Other
Self-identification / Other
Sexual Orientation:
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Heterosexual
Gay / Lesbian
Bisexual
Pansexual
Prefer not to respond
Self-identification / Other
Self-identification / Other
Race (check all that apply):
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Asian
American Indian/Alaska Native
Black / African American
Hawaiian / Pacific Islander
White
Prefer not to respond
Self-identification / Other
Self-identification / Other
Ethnicity:
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Latina / Latino / LatinX
Non-Latina / Latino / LatinX
Prefer not to respond
Self-identification / Other
Self-identification / Other
Comments
Thank you for completing and submitting the HU CFAR DEI Working Group survey!