2023 SHSMD Student and Diversity Enrichment Program

EDUCATIONAL OPPORTUNITIES

SHSMD Student and Diversity Enrichment Program
EDUCATIONAL OPPORTUNITIES

This program is specially designed for students who are interested in attending our SHSMD Conference in-person or virtual at a free or discounted registration rate. Selections will be based on financial need, attendance availability and interest in the profession. Preference will be given to under-represented populations.

Diversity is paramount to SHSMD's culture and success. Our dedication is both organic and deliberate.

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* 1. Contact Information

Name (First and Last) *

Name of College or University *

Current Degree Program *

City/Town *

State/Province *

ZIP/Postal Code

Country

Email Address (Use your student email) *

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* 2. Which of the following SHSMD educational / conference options interests you? (Select the ones that interest you the most)

Free Day at the 2023 SHSMD Connections Conference in Chicago, last day of conference on Tuesday, September 12. Limited supply available (approx 100)

Student Free Pass to attend the entire Conference 2023 SHSMD Connections Conference (Sunday, September 10 - Tuesday, September 12). Limited supply available (approx 10)

Free access to attend the live SHSMD Connections Virtual Conference (October 20) - includes in-person recordings. Limited supply available (approx 20)

Free access to view the SHSMD Connections Virtual Conference recordings from October 20 - includes recordings from the September 10-12 Conference. Limited supply available (approx 20)

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* 3. Based on your birth date, which generational cohort are you a member of?

Silent Generation (born between 1928-1944)

Baby Boomer Generation (born between 1945-1964)

Generation X (born between 1965-1981)

Millennial Generation (born between 1982-1995)

Generation Z (born between 1996-2012)

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* 4. Optional: Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other (please specify)

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* 5. Optional: Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban American, or some other Spanish, Hispanic, or Latino group?

Yes

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* 6. Optional: What is your current gender identity?

Male

Female

Transgender Male/Trans Male/Female-to-Male (FTM)

Transgender Female/Trans Woman/Male-to-Female (MTF)

Genderqueer, neither exclusively male or female

Non-binary

Another gender category, please specify

Prefer not to answer

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* 7. Optional: Do you think of yourself as:

Straight or heterosexual

Lesbian, gay, or homosexual

Bisexual

Something else

Don't know

Prefer not to answer

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* 8. Optional: Do you identify as an individual with a disability? (Select all that apply)

Yes, a physical disability

Yes, a learning disability

Yes, other type of disability

Prefer not to answer

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* 9. Briefly describe your degree program and how it relates to health care strategy or marketing / market development.

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* 10. How will SHSMD education / conference attendance benefit you? For example, how might it support your educational goals, skills, knowledge or career path?

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* 11. What part of the curriculum interests you most and why?

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* 12. Additional information about yourself you'd like us to know.

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* 13. Optional: Upload a copy of your transcript or student ID

Thank you, your request will be reviewed and processed. Recipients will be notified by mid-June.