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Center for Health Outcomes, Policy, & Evaluation Studies
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Membership Application
Senior Research Staff
Center for HOPES Staff
Membership Application
General Information:
First Name:
Middle Name:
Last Name:
E-mail Address:
NOTE: You
MUST
use a valid address or your application will not be processed.
Home Address:
Street Address:
City:
State:
ZIP:
Phone:
(
)
-
Work Address:
Street Address:
City:
State:
ZIP:
Phone:
(
)
-
Occupational Information:
Title:
Department:
College/Institution:
Please choose the type of membership you would like:
Center Scholar (Faculty members who are active in health policy or health services research, and are willing to submit proposals for externally funded research)
Center Associate Member (Faculty who have an active interest in health policy/health services research, but are not Center Scholars)
Center Affiliate (Individuals associated with the Center, but are not faculty. Included in this category are graduate and professional students in good standing with the University. Students will be nominated by a Center Member, faculty advisor or administrative official of their parent department or college.)
Center Visiting Member (Temporary Members)
Please paste your resume (plain text) into this box:
