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Registration

Please take a minute to register.

1. Name:
First
Last

2. E-Mail Address:
 
  Your e-mail address will be required to log back into the course.

3. Program Name — please specify if you are:
  • A program funded by the Maternal and Child Health Bureau's DRTE division (MCHB/DRTE):
    
  • Other program funded by MCHB/DRTE:
  
 
  • A program funded by HRSA:
  
 
 

• A non-HRSA funded program (e.g., hospital, university, public health clinic):
  


4. Your role can be described best as:
  Faculty
  Administrator
  Student
  Researcher
  Consumer or Family Member
  Other

5. For what purpose are you using these modules? Please check all that apply:
  Personal learning
  Required by accreditation or other mandate
  Required by organizational policy
  Faculty development
  Required/desired as part of coursework
  Other:
 

Contact Information: Phone (202) 687-5503 or (800) 788-2066; TTY: (202) 687-8899; 3300 Whitehaven Street, NW, Suite 3000 Washington, DC 20007-2401 Accessibility Copyright Georgetown University e-mail: cultural@georgetown.edu
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