Author(s) Information

* 1. Title of Session

* 2. Please provide contact information for Chair

* 3. Please provide contact information for Discussant

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

* 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).

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

* 7. Hispanic or Latino:

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

* 9. First Presentation

* 10. Second Presentation

* 11. Third Presentation