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Latina Researchers Conference 2016 Abstract Symposium Session
Author(s) Information
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1.
Title of Session
(Required.)
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2.
Please provide contact information for Chair
(Required.)
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
(Required.)
First Name
Last Name
Primary Organization/Institution
Title
Mailing Address
Preferred Email
*
4.
Are you a mid-career or senior investigator/scholar? (received advanced degree more than 7 years ago)
(Required.)
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).
(Required.)
Yes
No
6.
Please check all of the following categories that apply to you:
1st generation college graduate
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)
7.
Hispanic or Latino:
Yes
No
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
(Required.)
PresentationTitle
Fist Author First Name and Last Name
First Author Primary Institution/Affiliation
First Author Title
Please list other authors, if none, indicate NA
*
10.
Second Presentation
(Required.)
Presentation Title
Fist Author First and Last Name
First Author Primary Institution/Affiliation
First Author Title
Please list other authors, if none, indicate NA
*
11.
Third Presentation
(Required.)
Presentation Title
Fist Author First and Last Name
First Author Primary Institution/Affiliation
First Author Title
Please list other authors, if none, indicate NA:
