IHS Tribal Consultation Registration Form – Proposed Realignment

Description:
Thank you for registering for the Indian Health Service (IHS) Tribal Consultation on the proposed IHS realignment. Please complete the fields below to support planning, seating, and coordination for in-person and virtual sessions. Supporting materials, including the narrative, draft organizational chart, and FAQs, are available at: www.ihs.gov/newsroom/triballeaderletters/.

SECTION 1 – PARTICIPANT INFORMATION

Question Title

* 1. First Name

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* 2. Last Name

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* 3. Title / Role

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* 4. Organization Type

Tribe

Tribal Organization

Urban Indian Organization

Federal Employee

Other (please specify)

IHS Tribal Consultation Registration Form – Proposed Realignment

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Title / Role

Question Title

* 4. Organization Type

Question Title

* 5. Tribe / Tribal Organization / UIO Name

Question Title

* 6. Email Address

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* 7. Phone Number