2025-2026 Interest Group Advisory Committee Applications Please note the following: - Current Interest Group advisory committee members do not need to reapply in order to remain on the committee for their term.- This form needs to be completed in one sitting. Returning to the form to complete the information is not an option. - Applications to multiple IG advisory committees are permitted. Question Title * 1. Applicant Contact Information Full Name Degrees/Credentials Organization Title/Position City/Town State/Province Email Address Question Title * 2. Gender Man Non-Binary Woman I don't understand the question Prefer not to answer Something else: Question Title * 3. Pronouns She/Her He/Him They/Them Prefer Not to Answer Something Else: Question Title * 4. Ethnic Identity Latino or Hispanic Not Hispanic/Latino Prefer not to answer Question Title * 5. Racial Identity American Indian/Alaska Native Asian Black or African American Multi-racial Native Hawaiian/Other Pacific Islander White Prefer Not to Answer Other (please specify) Question Title * 6. Career Stage Senior Career Mid-Career Early Career Student Retired Prefer not to answer Other (please specify) Question Title * 7. Primary Workplace Academic/University Association, Professional Society Consulting, Contract Rsrch org, Rsrch Inst Foundation Government - federal Government - local Government - state Health care delivery org/health system Health plan/insurer Health Policy Center Industry (e.g. pharma, biotech, tech) Media/Publishing N/A Other (please specify) Question Title * 8. I would like to serve on the _________ Interest Group advisory committee. (Choose one) Child Health Services Research Disability Research Global Health Health Economics Health Equity Health Information Technology Health Workforce Interdisciplinary Research Group on Nursing Issues (IRGNI) Learning Health Systems Long-Term Services and Support Mental Health and Substance Use Research Oral Health Public Health Systems Research Quality and Value State Health Research and Policy Surgical and Perioperative Care Translation and Communication Women and Gender Health Next