Student Open Registration Form After completing this form, please allow 3-5 business days to receive a confirmation from Zoom with an access link and more information. With registration students will also receive a complimentary annual membership with the American Academy of HIV Medicine, granting access to educational opportunities, publications including a biweekly Clinical Research Update and a quarterly HIV Specialist Magazine, and you will join with a global network of HIV care providers. OK Question Title * 1. Name OK Question Title * 2. Race (select all that apply) American Indian or Alaska Native Asian or Asian American Black or African American Native Hawaiian or other Pacific Islander White Another race OK Question Title * 3. Ethnicity I am Hispanic or Latina/o/x I am not Hispanic or Latina/o/x OK Question Title * 4. Country of birth OK Question Title * 5. Personal email address OK Question Title * 6. Phone number OK Question Title * 7. Mailing address (will be used to deliver AAHIVM's free quarterly HIV Specialist magazine) OK Question Title * 8. What is the name of your school or training program? (ie Keck School of Medicine at USC) OK Question Title * 9. In which state, territory, or region is your school or training program? OK Question Title * 10. What is your current field of study? (select all that apply) Nursing (LPN, RN) Physician Assistant Medicine Pharmacy Nurse Practitioner Social Sciences Other (please specify) OK Question Title * 11. When are you due to graduate from your school or training program? OK Question Title * 12. Where could you see yourself working after graduation? (select all that apply) Private practice Community clinic or federally qualified health center Specialty practice Hospital or hospital-based clinic Public health or health policy Clinical research Health department VA or Indian Health Service Pharmaceutical industry Other (please specify) OK Question Title * 13. Please rank your preferences for which breakout session you would like to attend. Breakout session assignments are made on a first-come first-serve basis. A recording of all breakout sessions will be made available after the Student Open. 1 2 3 Research: How to get involved in clinical trials and research as a student. What do investigators do to support themselves? What is an abstract? Start putting together your publication record now and learn about research opportunities available to students today. 1 2 3 The Basics of Business in HIV Care: How to survive and thrive as a solo or small group practice. Tips for navigating salary negotiation and how to be your own professional champion. 1 2 3 The Hierarchy in Healthcare: Systemic racism in healthcare in the historical perspective and now. Different forms of systemic racism in healthcare – how do we navigate these mine fields? Recognizing and understanding the roots of implicit bias and associated stigma and its impact on the health of minority healthcare providers and patients. OK Question Title * 14. I am likely to make HIV prevention and care or research a central part of my career. Strongly agree Agree Somewhat agree Neither agree nor disagree Somewhat disagree Disagree Strongly disagree OK Question Title * 15. What skills do you expect to learn from the Student Open? OK Question Title * 16. How would you describe your current level of interest in HIV, hepatitis and emerging infectious disease work or research? Extremely interested Very interested Somewhat interested Not so interested Not at all interested OK Question Title * 17. Would you like to receive curated information on student or trainee opportunities in HIV, hepatitis and emerging infectious disease research? Yes No OK Question Title * 18. Would you like your name included in a raffle drawing to win a copy of AAHIVM's Fundamentals of HIV Medicine textbook? Yes No OK Question Title * 19. At the Student Open, during the break, a video will feature the insignia of participants' schools and training programs. If you would like your school or institution's logo or insignia to be included, please upload that file here. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File At the Student Open, during the break, a video will feature the insignia of participants' schools and training programs. If you would like your school or institution's logo or insignia to be included, please upload that file here. OK THANK YOU! WE LOOK FORWARD TO SEEING YOU WEDNESDAY, MARCH 30!