MHIRT Alumni Update

MHIRT Logo Welcome to the Minority Health and Health Disparities International Research Training (MHIRT) Program at CBU.

MHIRT Alumni, please fill out the following form so that we can update your profile in our files. Thank you.

First Name:
Last Name:
E-mail:
Alternate E-mail:
School Phone:
Home Phone:
Cell Phone:

School Address Information-
Address 1:
Address 2:
City:
State:
Zipcode:

Work Address Information-
Address 1:
Address 2:
City:
State:
Zipcode:

Home Address Information-
Address 1:
Address 2:
City:
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Zipcode:

In the box below, please enter your MHIRT year, your mentor's name, and your MHIRT location:

Please list any publications resulting from your work in the MHIRT program in which you are author or coauthor:

Please list your current occupation/position, current research interests, career interests, academic positions, and future goals:

How did your MHIRT experience influence your career path?

Degree information-
University-----------------Degree---------------------Date