Health Equity Footprint Survey

The Center for Health Equity Transformation (CHET) is collecting information from Northwestern faculty to highlight their health equity work. In the future, CHET will create a "Health Equity Footprint" online catalog on its website to include some of the information that you provide with your consent. The purpose of this Health Equity Footprint is to raise awareness among the Northwestern community and external stakeholders about each participating faculty member's work, which will also open pathways for people to collaborate and identify potential mentors.

If you have already opted in to our Health Equity Footprint but would like to modify your information, please email Araceli Estrada at araceli.estrada@northwestern.edu.

1Personal Information > 2Research > 3Review Your Entry
First Name
Last Name
Preferred pronouns

Preferred pronouns She/Her/Hers He/Him/His They/Them/Theirs Other Other
Would you like to opt-in to being included on the Health Equity Footprint webpage once it's live? If you opt out, we will keep your answers in our internal records and will only share your information if we are contacted with requests for subject matter experts in your field.

Would you like to opt-in to being included on the Health Equity Footprint webpage once it's live? If you opt out, we will keep your answers in our internal records and will only share your information if we are contacted with requests for subject matter experts in your field. Yes, I'd like to opt in. Please add me to the Health Equity Footprint webpage. No, I'd like to opt out. Please only keep my answers internally.
Email Address
Would you like your email address listed on our website so that people know how to get a hold of you? (some faculty profiles do not list contact information)

Would you like your email address listed on our website so that people know how to get a hold of you? (some faculty profiles do not list contact information) Yes No
Phone (For internal use; we will not list your phone number publicly) Phone (For internal use; we will not list your phone number publicly) - ### - ### ####
If applicable, on what geographical area does your work focus (e.g., South Side of Chicago, rural areas, Midwest, Scandinavia, etc.)?
With which Northwestern colleges and schools are you affiliated? (check all that apply)

With which Northwestern colleges and schools are you affiliated? (check all that apply) Weinberg College of Arts and Sciences School of Communication School of Education & Social Policy McCormick School of Engineering & Applied Science The Graduate School Medill School of Journalism, Media, Integrated Marketing Communications Pritzker School of Law Kellogg School of Management Feinberg School of Medicine School of Professional Studies Other Other
With which of the following do you identify, if any? (check all that apply)

With which of the following do you identify, if any? (check all that apply) Black/African American Latinx American Indian/Alaska Native Native Hawaiian/Pacific Islander Asian/Asian American European American Religious minority LGBTQ+/Non-gender conforming From a low-income background First-generation college student Immigrant Person with a disability From a rural community Ally for all I do not wish to answer Other Other
Some students and researchers seek potential mentors or collaborators with whom they share one or more of the identities above because they feel like they can relate to them based on shared experiences. What are your preferences for our use of the information about the identities you selected above?

Some students and researchers seek potential mentors or collaborators with whom they share one or more of the identities above because they feel like they can relate to them based on shared experiences. What are your preferences for our use of the information about the identities you selected above? I'd like to opt in to displaying my identities on the Health Equity Footprint webpage. I do not want my identities displayed on the Health Equity Footprint webpage, but I welcome being connected to potential mentees or collaborators that share my identities. I do not want my identities displayed on the Health Equity Footprint webpage, and I would not like to be connected to potential mentees or collaborators at this time.
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.