Thank you for your interest in joining the Indigenous Health Coalition. Filling out this application does not guarantee a position on the coalition, and applicants will be notified if they have been offered an opportunity for a trial membership position. 

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* 1. What is your first & last name?

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* 2. Members of this coalition must be Indigenous. What is your affiliation with the Native community?

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* 3. Tell us about how your lived experience as an Indigenous person might inform the work of the coalition.

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* 4. What is your age?

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* 5. Tell us a little about yourself (e.g. education, community work, work history):

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* 6. Why are you interested in joining the coalition?

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* 7. How do you currently contribute to your Indigenous community?

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* 8. Which sector(s) do you consider yourself a representative of, both personally and/or professionally? Check all that apply.

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* 9. What particular skillset(s) would you bring to the coalition, professionally and/or personally? Check all that apply.

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* 10. What Traditional skillsets do you have (e.g. beading, subsistence lifestyles, fishing, language teacher)?

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* 11. Which Tribal Nation has the best fry bread, and why?

CONTACT INFO

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* 12. Email address:

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* 13. Phone:

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* 14. Address (street, city, state, zip code)

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* 15. Where do you live?

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* 16. How did you hear about this opportunity?

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* 17. If you are not selected to join the coalition, would you still be willing to/interested in engaging in our efforts in other ways as new opportunities arise?

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