AAPCA1 Immigrant Child Health Committee - Join

Please complete this brief form to join the AAPCA1 Immigrant Child Health Committee.

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* 1. Practice Setting:

Community - private (solo or group)

Community - FQHC

Community - County Hospital

Academic setting

Other (please specify):

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* 2. Where are you in your career?

Medical Student

Resident

Fellow

In practice less than or equal to 10 years

In practice greater than 10 years

Emeritus/Retired

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* 3. Specialist vs Primary Care (please select one)

Primary Care

Specialist (list what kind below)

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* 4. What do you hope to get out of this task force?

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* 5. What ideas do you have for this task force?
(e.g. goals, activities, etc.)

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* 6. Which of the following working group(s) would you like to be a part of?

Education (focus on creating educational materials for clinicians and patients)

Legislative Advocacy (outreach to legislators, policy statements/op-eds, advocacy days)

Clinical Resources (focus on creating clinical tools to be used in practice)

Community Partnership (creating community partnerships to encourage collaboration)

Recruitment/Social Media (focus on recruiting new members and updating our social media sites with our activities)

AAPCA1 Immigrant Child Health Committee - Join

Question Title

* 1. Practice Setting:

Question Title

* 2. Where are you in your career?

Question Title

* 3. Specialist vs Primary Care (please select one)

Question Title

* 4. What do you hope to get out of this task force?

Question Title

* 5. What ideas do you have for this task force?
(e.g. goals, activities, etc.)

Question Title

* 6. Which of the following working group(s) would you like to be a part of?

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* 7. Full Name

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* 8. Email Address

Question Title

* 1. Practice Setting:

Question Title

* 2. Where are you in your career?

Question Title

* 3. Specialist vs Primary Care (please select one)

Question Title

* 4. What do you hope to get out of this task force?

Question Title

* 5. What ideas do you have for this task force? (e.g. goals, activities, etc.)

Question Title

* 6. Which of the following working group(s) would you like to be a part of?

Question Title

* 7. Full Name

Question Title

* 8. Email Address

* 5. What ideas do you have for this task force?
(e.g. goals, activities, etc.)