Intake form

Name *

Email address *

What is your current role in academia or the healthcare field?

What specific areas are you interested in addressing?

Please select at least one option.

Equity and Inclusion

Health Equity in Research

Cultural Humility, Intelligence, and Safety

Faculty Recruitment and Retention Strategies

Medical Education Continuum

Research Ethics

Inclusive Excellence Organizational Review

Community Engagement

What type of collaboration are you seeking?

Please select at least one option.

Consultation

Tailored Programs

Research Collaboration

Speaking

Advocacy

How did you hear about Dr. Sylk Sotto?

Please provide your organization or institution name.

What is your preferred method of communication?

Additional questions or comments