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Registration
Please complete the following form to be considered for Health Disparities Research Persons Network (HDRPN) membership. Network members should have significant expertise in aging research, minority health, health disparities, and recruiting and retaining older subjects from diverse and underrepresented backgrounds for research. Applicants should have proven experience in minority health, working with community-based organizations and public health institutions, grant management, or specific minority-related aging research. Expertise should be related to one or multiple minority groups. All applicants must have a minimum of 5 years of experience working with health disparities issues and hold an earned doctorate. Submission of your Curriculum Vitae (CV) will be requested upon registration and submission of a professional photo will be required upon membership approval.
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NIA Affiliation(s)
Please check the box(es) below that specify all of the NIA programs with which you are affiliated. If an NIA program is not listed, please check “Other Associate” and specify your affiliation to NIA in the comments section at the end of this form.
NIA Program Affiliation(s):
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Credential(s):
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Race/Ethnicity:
(*) Please specify your selection in the comments section at the end of this form.
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Language Proficiency (Ability to speak, read and write):
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Discipline(s)/Occupation(s)/Field(s)
Please check all the boxes below that apply to your discipline(s), occupation(s) and/or field(s). Your choices will be the variables used by this web tool to select network members with specific expertise.
Discipline Occupation Field:
(*) Please specify your sub-specialties in the comments section at the end of this form.
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Research Focus
Please check all of the boxes below that apply to your research focus. Your choices will be the variables used by this web tool to select network member with specific expertise.
Research Focus:
(*) Please specify your selection in the comments section at the end of this form.
Information for: Research Focus : Check all the areas that reflect your research focus (multiple areas may be selected). * +
Method of consultation (check all methods you are willing to use) :
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Aging Research Experience/Expertise with Specific Populations
Please check below all populations with whom you have aging research experience/expertise.
Black/African American:
(*) Please specify your selection in the comments section at the end of this form.
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Hispanic/Latino:
(*) Please specify your selection in the comments section at the end of this form.
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Asian American:
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Native Hawaiian/Other Pacific Islanders:
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American Indian/Alaska Native:
(*) Please specify your selection in the comments section at the end of this form.
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Other Specific Population:
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Your registration form will now be considered for HDRPN membership. You will be notified of your membership status by the email you provided above. Thank you for your interest in the NIA Health Disparities Resource Persons Network.

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