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UNIVERSITY OF PITTSBURGH
2020 STEEL CITY HEALTH CAREERS DIVERSITY CONFERENCE
3.
2020 STEEL CITY HEALTH CAREERS DIVERSITY CONFERENCE
April 3 & 4, 2020
University of Pittsburgh Schools of the Health Sciences
1.
Address
Name
Status (Student, Advisor, Faculty/Teacher)
Address
Address 2
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Email Address
Cell Phone Number
2.
Preferred pronouns
They/them/their
He/him/his
She/her/hers
Other (please specify)
*
3.
Academic Institution
(Required.)
4.
Anticipated year of Graduation (if applicable)
5.
Students: Please list your primary health profession interest. If you are interested in a dual degree program (i.e., MD/PhD, or DMD/MPH) please note this.
***
Note: Bioengineering is the only Engineering discipline which will be represented.
6.
Please specify any dietary needs.
Vegetarian
Vegan
Allergy to nuts
Allergy to dairy
Allergy to seafood
Gluten Free
Details
7.
I will ride the bus from my campus (details provided separately).
Yes
No
8.
I will arrange my own transportation to Pitt.
Yes
9.
Advisors/Teachers: How many students will accompany you?
10.
Advisors/Teachers from out of town: Have you reserved hotel space?
Yes
No
11.
I would like to take a tour:
General Campus Tour
Specific Health Science School
Please specify Health Sciences School for tour:
12.
We would like to make our event as accessible as possible. Please specify any accommodations required.
ASL Interpreter
Other language support
Video captioning
Other (please describe below)
Hotel reservations can be made with the Wyndham Pittsburgh University Center. $129/night. Book here:
Wyndham Reservations
