HERE Center Interest Form

Thank you for your interest in becoming a HERE Center partner, we are dedicated to improving health equity for individuals in the San Fernando Valley (SFV) and surrounding communities through education, community-academic partnerships, and health disparities research. To achieve this mission, we need all types of partners: students, faculty, community-based organizations, and small businesses. Please fill out this interest form and we will work on identifying ways the Center can support you. If you have any questions, comments, or suggestions please email herecenter@csun.edu.

Are you a:

student
faculty member/staff
community-based organization/ nonprofit organization
for-profit organization/ small business
community member

Full name:

Email address:

Phone number:

What organization are you affiliated with (e.g. CSUN)?

Best way to contact you:

email
phone

Which topics are you interested in? Please check all that apply (click cntl/cmd or shift while selecting).

To select multiple options in a row, click and drag your mouse or hold down Shift when selecting. To select non-sequential options, hold down Control (on a PC) or Command (on a Mac) when clicking. To deselect an option, hold down Control or Command and click on a selected option.

Would you like to subscribe to the HERE Center's newsletter?

Yes
No

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