National Historically Black Colleges and Universities

Research Network

for Health Services and Health Disparities

 

Membership Application Form

The National Historically Black Colleges and Universities (HBCU) Research Network for Health Services and Health Disparities (The Network) is a non-profit organization established in 1996 for the purpose of promoting health services research by and for African Americans and other underserved populations.  Methodologies for achieving this purpose include:

  • Discussing health issues

  • Encouraging collaboration

  • Disseminating research findings

  • Establishing partnerships among HBCUs, State and Federal agencies, and majority institutions

  • Facilitating access of HBCUs to major research initiatives

Membership in The Network is open to individuals who have earned a Master’s degree or higher, hold a position as a researcher or faculty member at an HBCU that offers the bachelor’s degree or higher, and are interested in identifying strategies to eliminate health disparities among African American and other underserved populations.

   Fill in Form and Print

Name:
Position/Title: 
Business Address: 
City/State/Zip Code:
Business Phone:

     
Fax: 
Home Address: 
City/State/Zip Code:
Email:

 

  

 

 

Please identify your area of research interest/specialization from the items below (you may select more than one):

01 Diabetes

02 Cancer

03 Mental Health/Counseling

04 Planning/Development

Other   

05 Nutrition

06 Medicine/Dentistry

07 Public Policy

08 Nursing

09 Program Evaluation

10 Statistics/Data Analysis

11 Health Promotion 

 

If other please explain

Make two copies of this application. Keep one and send the other one to us.

 

 

Please enclose your check or money order for $100.00 payable to the HBCU Research Network and return your application with payment to: 

Dr. Ivis Forrester Anderson

Post Office Box 371

Reisterstown , MD   21136


 

 

Phone:  443-885-4043   |   Fax:  443-885-8309 

Email: dr__ivisforrester@hotmail.com 

 

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