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Cal STAPH Membership Form
Please complete the following information to register as a member of Cal STAPH. You must re-submit the membership form each year to maintain active membership.
If you have any questions, please contact the Cal STAPH Coordinator at
staph@berkeley.edu
.
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* Indicates required question
General Information
First Name
*
Your answer
Last Name
*
Your answer
UC Berkeley Email Address
*
Please enter your UC Berkeley email address, even if this is not your primary email account. This will be your Cal STAPH User ID.
Your answer
Cell Phone Number
*
xxx-xxx-xxxx
Your answer
Name of Emergency Contact, their phone number, and relationship to you
*
Your emergency contact person must be someone who can legally make medical decisions on your behalf.
Your answer
Expected Year of Graduation
*
Please provide your best estimate.
Choose
2024
2025
2026
2027
2028
2029
What degree program are you enrolled in?
*
Master's (MA, MPH, or MS)
Doctoral (PhD or DrPH)
Other:
Area of Concentration
*
Choose
Biostatistics
Doctor of Public Health
Environmental Health Sciences
Epidemiology
Epidemiology/Biostatistics
Global Health & Environment
Health & Social Behavior
Health Policy & Management
Infectious Diseases & Vaccinology
Interdisciplinary
Joint Medical Program
Maternal & Child Health
On-Campus/Online MPH
Public Health Nutrition
Background and Experience
Please note that no particular skill set or experience is required to become a member of Cal STAPH.
Computer skills
(Intermediate level and above)
ArcGIS
Epi Info
Microsoft Access
Microsoft Excel
R
SAS
SPSS
Stata
Other:
Languages spoken other than English
(Intermediate level and above)
Cantonese
French
German
Mandarin
Russian
Spanish
Tagalog
Vietnamese
Other:
Interests
Which of the following Cal STAPH activities would be of interest to you?
*
Choose all that apply.
Outbreak and disease investigations
Disease surveillance
Public health response following disaster or emergency
Community assessments or surveys
Disaster preparedness drills or exercises
Public health education
Data collection, entry, and analysis
Case or contact investigation (by telephone or in person)
Career path development seminars or panels
Clinical support (e.g. vaccination or medication clinic)
Other:
Required
Which of the following activities best match your skills or interests?
*
Choose all that apply.
Data collection instrument design
Chart review or data entry
Data analysis or interpretation
Case or contact investigation (by telephone or in person)
Evaluation support (e.g., public health exercise evaluation)
Educational material development
Environmental investigation support
Laboratory support
Clinical support (e.g., vaccination or medication clinic)
Other:
Required
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