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Sydney Global Maternal and Child Health Network (SGMCHN) Membership Application
'IMPROVING MATERNAL, CHILD AND ADOLESCENT HEALTH IN DISADVANTAGED POPULATIONS'
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Email
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Your email
Personal details
Title
*
Your answer
Surname
*
Your answer
First name
*
Your answer
Affiliation(s)
Select from the following (multiple choice)
*
The University of Sydney
Sydney School of Public Health, The University of Sydney
The Children's Hospital at Westmead Clinical School
The Children's Hospital at Westmead (non-Clinical School)
Sydney Children's Hospital, Randwick
Kids Research
NGO - Cerebral Palsy Alliance
NGO - World Vision
NGO - MSF
UN organisation - WHO
UN organisation - UNICEF
Other (select and provide details below)
Required
Other affiliation(s) not listed above
Your answer
Professional background
Select from the following (multiple choice)
*
Medical practitioner
Nurse
Allied health professional - Physiotherapist
Allied health professional - Occupational therapist
Allied health professional - Speech therapist
Allied health professional - Dietitian
Academic
International development
Student - PhD
Student - Masters
Student - Medical
Student - Undergraduate
Other (select and provide details below)
Required
Other profession not listed above
Your answer
Areas of involvement
Select from the following (multiple choice)
*
Research - Randomised controlled trials
Research - Observational/surveillance studies
Research - Epidemiological
Research - Clinical
Research - Health services/operational/implementation
Research - Health economics
Research - Policy
Research - Qualitative
Research - Systematic reviews and meta-analyses
Health services/policy (not research)
Education/capacity building
Clinical care/outreach
Other (select and provide details below)
Required
Other areas of involvement not listed above
Your answer
Geographic focus
Southeast Asia region
Bangladesh
India
Indonesia
Myanmar
Sri Lanka
Thailand
Timor-Leste
Other (select and list other countries in this region below)
Other countries in Southeast Asia region not listed above
Your answer
Western Pacific region
Cambodia
China
Fiji
Lao People's Democratic Republic
Malaysia
Papua New Guinea
Philippines
Solomon Islands
Vietnam
Other (select and list other countries in this region below)
Other countries in Western Pacific region not listed above
Your answer
African region
Botswana
Ethiopia
Kenya
Malawi
Nigeria
Rwanda
South Africa
South Sudan
Uganda
United Republic of Tanzania
Zambia
Zimbabwe
Other (select and list other countries in this region below)
Other countries in African region not listed above
Your answer
Thematic alignment
Select from the following (multiple choice)
*
Nutrition: includes under- and over-nutrition (obesity and nutritional deficiencies)
Infection and Immunisation: includes transmissible disease, infection control and prevention
The first 1000 days: includes pregnancy, neonatal and infant care, normal growth and development
Disability and Chronic disease: includes cerebral palsy, congenital abnormalities, metabolic and other chronic disease
Other (select and provide details below)
Required
Other thematic areas not listed above
Your answer
Ongoing research projects/programs (if any)
This section is optional. Please number projects/programs if >1.
Project/program title(s)
Your answer
Main study aim(s)
Your answer
Location(s)
Your answer
Funding source(s)
Your answer
Partner organisation(s)
Your answer
Study period(s)
Your answer
Personal details
Title
*
Your answer
Surname
*
Your answer
First name
*
Your answer
Affiliation(s)
Select from the following (multiple choice)
*
The University of Sydney
Sydney School of Public Health, The University of Sydney
The Children's Hospital at Westmead Clinical School
The Children's Hospital at Westmead (non-Clinical School)
Sydney Children's Hospital, Randwick
Kids Research
NGO - Cerebral Palsy Alliance
NGO - World Vision
NGO - MSF
UN organisation - WHO
UN organisation - UNICEF
Other (select and provide details below)
Required
Other affiliation(s) not listed above
Your answer
Professional background
Select from the following (multiple choice)
*
Medical practitioner
Nurse
Allied health professional - Physiotherapist
Allied health professional - Occupational therapist
Allied health professional - Speech therapist
Allied health professional - Dietitian
Academic
International development
Student - PhD
Student - Masters
Student - Medical
Student - Undergraduate
Other (select and provide details below)
Required
Other profession not listed above
Your answer
Areas of involvement
Select from the following (multiple choice)
*
Research - Randomised controlled trials
Research - Observational/surveillance studies
Research - Epidemiological
Research - Clinical
Research - Health services/operational/implementation
Research - Health economics
Research - Policy
Research - Qualitative
Research - Systematic reviews and meta-analyses
Health services/policy (not research)
Education/capacity building
Clinical care/outreach
Other (select and provide details below)
Required
Other areas of involvement not listed above
Your answer
Geographic focus
Southeast Asia region
Bangladesh
India
Indonesia
Myanmar
Sri Lanka
Thailand
Timor-Leste
Other (select and list other countries in this region below)
Other countries in Southeast Asia region not listed above
Your answer
Western Pacific region
Cambodia
China
Fiji
Lao People's Democratic Republic
Malaysia
Papua New Guinea
Philippines
Solomon Islands
Vietnam
Other (select and list other countries in this region below)
Other countries in Western Pacific region not listed above
Your answer
African region
Botswana
Ethiopia
Kenya
Malawi
Nigeria
Rwanda
South Africa
South Sudan
Uganda
United Republic of Tanzania
Zambia
Zimbabwe
Other (select and list other countries in this region below)
Other countries in African region not listed above
Your answer
Thematic alignment
Select from the following (multiple choice)
*
Nutrition: includes under- and over-nutrition (obesity and nutritional deficiencies)
Infection and Immunisation: includes transmissible disease, infection control and prevention
The first 1000 days: includes pregnancy, neonatal and infant care, normal growth and development
Disability and Chronic disease: includes cerebral palsy, congenital abnormalities, metabolic and other chronic disease
Other (select and provide details below)
Required
Other thematic areas not listed above
Your answer
Ongoing research projects/programs (if any)
This section is optional. Please number projects/programs if >1.
Project/program title(s)
Your answer
Main study aim(s)
Your answer
Location(s)
Your answer
Funding source(s)
Your answer
Partner organisation(s)
Your answer
Study period(s)
Your answer
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