R2A Summit Registration - University of Kentucky College of Social Work

REGISTRATION

Please contact Lydia Wade for any questions or concerns regarding you registration submission.

First Name

Last Name

Pronouns

Make a selection of pronouns to be printed on your name tag

Specify you pronouns below:

Phone Number

Email Confirmation

Institution/Organization

Type of Institution/Organization

Please specify other institution/organization type:

Current Student

Expected Graduation Date

MM/YYYY

What is your current professional title?

Academic discipline you received your doctoral degree in (or are in school for):

Example: Clinical Psychology, Social Work, Economics, Child Development, etc.

Are you a CWRN Member?

YesNo

Meals will be provided during the summit. Please share any dietary restrictions below:

Please Specify:

Will you need any special accommodations during the summit?

Please specify:

We hope to have some resources available to provide limited scholarships to CWRN members whose institutions do not provide support for conference travel, or for CWRN members who would be unable to attend the Summit without outside resources. If these resources become available, would you be interested in receiving information on funding opportunities?

YesNo

Please explain why you would need outside resources:

Did you participate on one of the nine R2A Grantee teams?

YesNo

Who was/were the PI(s) of the grant?

What state was the research primarily conducted in?

Contact Information