Latina Researchers Conference 2016 Abstract Symposium Session

Author(s) Information

Question Title

* 1. Title of Session

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* 2. Please provide contact information for Chair

First Name

Middle Name

Last Name

Primary Organization/Institution

Title

Mailing Address

Preferred Email

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* 3. Please provide contact information for Discussant

First Name

Last Name

Primary Organization/Institution

Title

Mailing Address

Preferred Email

Question Title

* 4. Are you a mid-career or senior investigator/scholar? (received advanced degree more than 7 years ago)

Yes, I am a midcareer investigator/scholar

Yes, I am a senior investigator/scholar

Yes, I am a retired investigator/scholar

No, I am an early career investigator (received advanced degree within 7 years)

Not applicable

Other (please specify)

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* 5. Are you a member of an underrepresented population interested in research activities? (Examples include but are not limited to persons who: are from a racial or ethnic minority populations, grew up in a low-income community, is a first generation college student, rural, other under-represented group).

Yes

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* 6. Please check all of the following categories that apply to you:

1st generation college graduate

Raised in a low-income community

From a rural community

Attended a Historically Black College or University

Attended a Hispanic Serving Institution

Not applicable

Other underrepresented status (Please specify)

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* 7. Hispanic or Latino:

Yes

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* 8. What do you identify as your race (Check all that apply)?

White, non-Hispanic

Black, non-Hispanic

Hispanic/Latina(o) White

Hispanic/Latina(o) Afro-descendant

Hispanic/Latina(o) Mestizo(a)

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

Other (please specify)

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* 9. First Presentation

PresentationTitle

Fist Author First Name and Last Name

First Author Primary Institution/Affiliation

First Author Title

Please list other authors, if none, indicate NA

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* 10. Second Presentation

Presentation Title

Fist Author First and Last Name

First Author Primary Institution/Affiliation

First Author Title

Please list other authors, if none, indicate NA

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* 11. Third Presentation

Presentation Title

Fist Author First and Last Name

First Author Primary Institution/Affiliation

First Author Title

Please list other authors, if none, indicate NA: