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SPIPA Cancer Advisory Committee Member Application ~ Organization

The SPIPA Cancer Advisory Committee is dedicated to reducing the burden of cancer amount the American Indian / Alaska Native (AI/AN) communities served by SPIPA. The mission is to collaborate with tribal leaders, community members, tribal clinic staff, SPIPA staff, and other tribal and community organizations to create and implement effective cancer prevention and control strategies.

Thank you for your interest in serving on the Advisory Committee. Please complete this short application. We will contact you within 5 business days with an update on your application.
1.First and Last Names(Required.)
2.What organization do you work for?(Required.)
3.What is your job title?(Required.)
4.Phone Number(Required.)
5.Email Address(Required.)
6.What is your mailing address?(Required.)
7.How do you prefer to be contacted?(Required.)
8.Website Address(Required.)
9.What are your pronouns?
10.Are you a Tribal member?(Required.)
11.Do you work for a Tribe?(Required.)
12.What Tribe are you a member of or work for?(Required.)
13.What about being a part of the Advisory Committee interests you?(Required.)
14.Which parts of the 2024 - 2034 SPIPA Tribal Cancer Plan are you interested in assisting with? If you are not familiar with the Cancer Plan, please visit the SPIPA website at spipa.org/cccp.(Required.)
15.What resources can your organization provide to support the Advisory Committee's activities?(Required.)