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NYS HIV Advisory Body (HAB) Membership Information Demographics

Demographic and self-identification information is requested to ensure parity, inclusion and representation. This information will remain confidential.

Applications for membership are accepted on an ongoing basis. Applicants must either live or work in New York State. Individuals who work for groups, entities, or organizations that provide HIV prevention, care and treatment, or HIV related supportive services to clients, are encouraged to apply. Persons living with HIV are also encouraged to apply. To apply for a seat on the HIV Advisory Body, complete this online confidential questionnaire.

Please direct questions to HAB@health.ny.gov
1.What is your full name?
2.What is the name of your organization and your professional title?
3.If applicable, what is your work address?
4.What is your home address?(Required.)
5.What are the best phone numbers to reach you?(Required.)
6.Please input your primary and secondary email addresses(Required.)
7.What is your preferred mailing address?(Required.)
8.Which of the below regions will you be representing?(Required.)
9.Please upload your resume*.
No file chosen
10.Please upload your letter of recommendation.
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NYS HIV Advisory Body (HAB) Membership Information Demographics
Demographic and self-identification information is requested to ensure parity, inclusion and
representation. This information will remain confidential.
11.I identify as:(Required.)
12.I identify as:(Required.)
13.I identify as: (Check all that apply)(Required.)
14.My age range is:(Required.)
15.I am living with HIV/AIDS:
16.Are you willing to disclose your HIV status to the HAB?
(Disclosure is encouraged but not required)
17.Please indicate which categories you would be able to
represent as a member of the HAB. (Check all that apply)(Required.)
18.Special skills, areas of expertise, or life experiences you would bring to the HAB
Special skills, areas of expertise, or life experiences you would bring to the HAB
19.I have skills/ experience in: (Check all that apply)(Required.)
20.I have personal and/or professional experience regarding
these populations: (Check all that apply)(Required.)
21.Would you like to include any other expertise, skills,
or experiences?
22.Do you have any past experience on planning bodies? Please explain.(Required.)
23.Briefly describe your work (paid or voluntary) with HIV/AIDS prevention, service provision or health care. Within the answer, please specify your knowledge or familiarity with HIV/AIDS prevention and/or health care programs and strategies. How many years have you been working on HIV/AIDS issues?
24.Why would you like to be a HAB member?(Required.)
25.What skills/strengths do you feel you might contribute to the work of the HAB?
26.Please specify if you have any accessibility needs:
27.If you are affiliated with any organizations, please list their names and disclose your capacity in those organizations. Capacity options include but are not limited to: employee, consultant, volunteer, or board member.
28.Are you available to attend one in-person meeting annually?(Required.)
29.How did you hear about the HIV Advisory Body (HAB)?
30.Please read the below statement and sign your name in the text box: I will commit to: Attend and participating actively in Orientation; Serve on the HAB as a member of one Committee and attend all scheduled monthly committee conference calls; Participate in all four, full meetings during a planning cycle; Prepare for each meeting by reading all pre-distributed materials; Consider the needs of NYS and not allow my concern to be limited to personal or special interests; Attend full HAB meetings from Call to Order until Adjournment. I have considered my personal and professional obligations and do not believe them to be a barrier to my active participation as a HAB member.(Required.)