Name(Required) First Last Email(Required) Enter Email Confirm Email Password(Required) Enter Password Confirm Password Profile InformationPronounsJob Title(Required)State/Territory(Required)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaGuamNorthern Mariana IslandsPuerto RicoU.S. Virgin IslandsOutside of the United States of AmericaPlease select which type of organization that best represents where you work.(Required) Health Department Federal Agency Other Government Agency Membership Organization Non-profit Organization Community-Based Organization Philanthropy Healthcare Organization Student Academic Institution Business/For-Profit Company Unemployed Other Name of Organization/Institution(Required)Name of Health Department(Required)Level of health department(Required)CityCountyStateTribalOther (please specify)Other Level(Required)Size of Dept Jurisdiction(Required)<25,00025,000-49,99950,000-99,999100,000-249,999250,000-499,999500,000-999,9991,000,000+Is there a communications specific staff person/team in your organization?(Required) No, no communications specific staff Yes, one staff Yes, multiple staff/a team Which of the following describes your role/department you work in?(Required) Communications Community Outreach Director/Leadership Epidemiology Health Education Research Other (please specify) Other Role/Dept.(Required)Please select which best describes your communications role.(Required) Communication Director Public Health Information Officer (PIO) Health Promotion Specialist Social Media Web/Website Team Translations Other (please specify) Other communications role(Required)Are you a manager/supervisor of other staff as a part of your role?(Required) Yes No Years in role(Required)Less than a year1-2 years2-5 years5-7 years7-9 years10 years or morePlease share any degrees and/or certifications you have related to public health communications.(Required)Race/Ethnicity American Indian/Alaska Native Asian Black or African American Hispanic/Latine Native Hawaiian or Other Pacific Islander White Other (please specify) Prefer not to answer Other Race/EthnicityAre you open to your email address being shared with other PHCC Academy participants?(Required) OK to share email Do not share email Are there topics you are interested in more training on?PhoneThis field is for validation purposes and should be left unchanged.
