Global Health Affiliate Registration Form

 

  1. Last Name 

  2. First Name         Email    

  3. Health Field

Medicine  Nursing   Pharmacy  Public Health  Veterinary Medicine
Other Health Related Field ( Please specify)  

  1. Affiliation

  UW Faculty or Staff
  UW Student
  Community Affiliate

  1. Health Topics on Interest (check all that apply)

  Maternal and Child Health and Reproductive Health
  Infectious Disease
  Nutrition
  Chronic Disease and Injury
  Mental Health
  Environmental Health
  Humanitarian Emergency Response
  Veterinary Medicine
 Other (Please specify)  

  1. Geographic Regions of Interest/Experience (check all that apply)

  Africa
  Asia
  Europe
  Latin America
  Middle East

  1. Country Specific Interest/Experience

  1. Language Skills

  Arabic
  Chinese
  French
  Spanish
  Portuguese
Other (Please specify) 

  1. Type of Work (check all that apply)

  Clinical Service
  Training
  Research
  Consultation

  1. Briefly describe your areas of expertise and interest

 

 

The Center for Global Health aims to coordinate, strengthen and expand global health activities within the UW-Madison and beyond through sustained partnerships and a network of Global Health Affiliates. 

Affiliates support and benefit from a rich spectrum of global health educational opportunities through seminars and an annual symposium. We will launch a Global Health Certificate beginning in the fall 2006 that will prepare students and mid-career health professionals for careers in global health. The CGH will also catalyze and support interdisciplinary global health research, exchanges and service projects.

Global Health Affiliates are UW faculty, staff, alumni, students and others in the community who are interested and involved in global health.  Global Health Affiliates will:

  • Receive invitations and updates on activities of the CGH;
  • Gain access to a data-base of global health affiliates which will enable you to network with individuals with similar geographic or topical interests; and
  • Contribute to building a community of teachers, students and scholars engaged in understanding and addressing global health challenges.

Please allow 30 days for confirmation of your Global Health affiliate status.