My journey

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* 1. Full Name

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* 2. Credentials - CHES, MCHES, MPH, PhD, MS, MA, BS, BA, etc.

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* 3. CHES/MCHES Number

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* 4. Employer

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* 5. Job Title

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* 6. Email Address

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* 7. Phone Number

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* 8. Tell us about you. Provide stories, facts, details, etc. Where are you from? What school did you attend? etc.,

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* 9. What I do when I'm not at work?

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* 10. Here's my media mix

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* 11. Tell us one fun fact about you

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* 12. Why did you choose a career in health education/health promotion?

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* 13. If you were not in your current position, tell us what you would be doing instead

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* 14. What is your work setting?

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* 15. What is the name of your employer/school/university/organization/hospital?

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* 16. Where is your work setting?

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* 17. What makes your current or future career in public health, health promotion or health education exciting?

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* 18. What is the best career advice you received? From whom?

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* 19. What is the best career advice you would give?

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* 20. Of the Seven Areas of Responsibility - which one do you use most?

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* 21. How long have you been a SOPHE member (National or Chapter)?

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* 22. What volunteer activities are you involved in with SOPHE? Other organizations?

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* 23. Upload your photo

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* 24. PERMISSION: I hereby grant the Society for Public Health Education [SOPHE] and its representatives, successors, and licensee’s permission to use my personal statement, photo, image or likeness in any and all of its publications or any medium, including print and electronic, or other digital media, without payment or other consideration. 

I understand and agree that all materials become the property of the SOPHE. I hereby grant permission to SOPHE to edit, crop, or retouch such materials and waive any right to inspect the final versions or photographs.

I hereby irrevocably authorize the Society for Public Health Education to edit, alter, copy, exhibit, publish, or distribute these statements. photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears.  Additionally, I waive any right to royalties or other compensation arising or related to the use of the statement or photo.
 
I hereby hold harmless, release, and forever discharge the Society for Public Health Education from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ, UNDERSTAND AND AGREE TO THE STATEMENT AND PHOTO RELEASE TERMS. I ALSO AFFIRM THAT I AM 18 YEARS OF AGE OR OLDER BY SELECTING TO ANSWER "YES."

Thank you for your participation in the ongoing project, Faces of health education specialists.
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