First Name

Last Name

Email

What membership type are you applying for? Mentored Full Core Adjunct

Which department(s) do you have an active faculty appointment?

What other Center(s), Program(s), or Initiative(s) are you affiliated with?

Area of research practice

How does your current work intersect with COPHI’s focus areas?

In what ways do you hope to contribute to COPHI’s mission?

List your top 3-5 peer reviewed publications within the last 5 years that demonstrate COPHI focus

List your top 3-5 Conference and/or workshops within the last 5 years that demonstrate COPHI Focus

What types of scholarly or practice-based products aligned with COPHI’s focus are you aiming to develop in the next 1–2 years (e.g., manuscripts, grants, white papers, community deliverables)?

In what ways do you hope to benefit from and contribute to affiliation with COPHI?

Submit