Community Organizing Waitlist

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Community Organizing Workshop Waitlist

Our Pre-Intern Orientation Community Organizing Workshop is at capacity. Please fill out the form below if you would like to be added to the waitlist and we will let you know by May 21, 2021 if a spot becomes available

Full Name

First Name

Last Name

What do you prefer to be called?

Email address (preferably non-institutional email like a Gmail address)

Phone Number

(this will be used by your small group coach to contact you with more information at the beginning of June)

Academic Medical Center?

i.e. MGH

Residency Program

i.e. Internal Medicine

What Year of Residency will you be starting in July 2021

If you entered "other", please describe here

If not, leave blank

Can you make a firm commitment to attend the workshop on Sunday, June 13th from 9AM-4PM? Please note that, due to the interactive nature of the workshop, we will not be able to have participants arrive late, leave early or join for only part of the day.

In order to be added to the waitlist, you must be able to commit to attending the entire day.

Yes, I can commit to attending the entire session on Sunday, June 13th

For the purposes of creating diverse small groups, please share the following information if you are comfortable.

What race / ethnicity are you?

Leave blank if you prefer not to answer

Pronouns?

Leave blank if you prefer not to answer

Where are you from?

Leave blank if you prefer not to answer

Would you be interested in future community organizing and health equity programs developed by this group?

Would you like to be added to our mailing list?

Community Organizing Workshop Waitlist

Cambridge Health Alliance

Center for Health Equity Education and Advocacy