Member Survey - Association of Psychologists in Academic Health Centers (APAHC)

Career Level *

Organization / University *

Phone *

Address *

Address 2

City *

State * State

Zip *

Country * Country

Gender (Hold the 'Ctrl' key for multiple selections.) * Gender (Hold the 'Ctrl' key for multiple selections.)

What are your preferred personal pronouns?

What is your Ethnicity? *

Hispanic Origin *

What is Your Race? (Hold the 'Ctrl' key for multiple selections.) *

Do you have a disability? Individuals with disabilities, who are defined as those with a physical or mental impairment that substantially limits one or more major life activities, as described in the Americans with Disabilities Act of 1990, as amended. * Do you have a disability? Individuals with disabilities, who are defined as those with a physical or mental impairment that substantially limits one or more major life activities, as described in the Americans with Disabilities Act of 1990, as amended.

Are you a military veteran? *

How did you hear about us? How did you hear about us?

What is the name of your colleague?

What is your highest earned psychology degree? * What is your highest earned psychology degree?

Date Doctorate was Conferred or Graduation Date *

(This field requires a format of mm/dd/yyyy.)

Work Setting * Work Setting

Type of Hospital *

Type of Ambulatory Care Facility *

Leadership Roles

Educational leadership roles national or institutional

Clinical leadership roles national or institutional

Research leadership roles national or institutional

OtherOther

Are you a Member of the APA? *

Please indicate which national organizations in which you hold a leadership role.
(Check all that apply and provide any additional by checking "other.")

Are you a Member of Division 12? *

Please List Any Other Division Memberships

Do You Hold a Position In AAMC? *

Please Describe Your Current Involvement with AAMC? *

Do You Want To Subscribe to the APAHC Listserve? *

Membership Checkout Complete!

If you are new here, thank you for becoming a member!
If you are a current member, thank you for renewing your membership!

Membership Checkout Complete!

If you are new here, thank you for becoming a member! If you are a current member, thank you for renewing your membership!

If you are new here, thank you for becoming a member!
If you are a current member, thank you for renewing your membership!