Health Equity Challenge Application

Thank you for your interest in the Health Equity Challenge, a program of the UCLA Center for Health Policy Research (CHPR). Please complete and submit your application no later than Monday, November 6, 2023. Questions can be directed to Kathryn Kietzman, project director, at kietzman@ucla.edu.

Program Eligibility

Are you a graduate student at UCLA? (Note: To be eligible, you must be currently enrolled in a UCLA graduate level, academic degree granting program) *

Yes

No

Contact Information

First Name *

Last Name *

Primary E-mail Address *

Primary Phone Number *

Address Line 1 *

Address Line 2

City *

State *

ZIP Code *

County *

Demographics

Which of these categories describe your racial/ethnic background? (Choose all that apply): *

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian/Pacific Islander

White, Hispanic/Latinx

White, non-Hispanic

Other

How did you learn about the Health Equity Challenge? (Select all that apply): *

Announcement

Another Student

An Adviser/Faculty Mentor

Community Based Organization

Social Media

Website, please describe

Other, please describe

Vision for Program Participation (open responses)

Prior to completing this section of the application, we recommend writing out your responses in a separate document and copying/pasting into this web form. This web form application does not allow you to save responses and return to it later. [Note: please use 12-pt font, single spaced]

Provide a statement that conveys your high-level aspiration for reducing health care disparities and why this is so important to you. (Note: we are especially interested in your clarity of purpose.) *

Describe the kind(s) of innovations you will consider developing under the Health Equity Challenge. – for which population(s) or subpopulation(s) (e.g., immigrant children, older Californians, people who are homeless) and in what domain(s) (e.g., public health, health care, social services)? (Note: we are especially interested in the originality and potential impact of your proposed ideas.) *

Describe the kind(s) of community-based partners with which you might work (e.g., community health centers, substance abuse recovery programs). Feel free to identify specific organizations with which you might collaborate. For the purpose of this competition, you are not allowed to select a community partner (or its affiliate) with which you have an employment and/or other financial relationship. (Note: we are especially interested in the feasibility of your ideas.) *

Potential Adviser/Mentor (optional)

Do you have the potential support of an academic or community adviser/mentor?

Yes

No

If Yes, please provide us with their name, affiliation, and email address: *

We encourage you to select a new adviser/mentor for the purpose of this program, to expand upon existing mentor relationships. Note: While you are not required to identify a mentor, we encourage you to search for potential mentor candidates in your topic area. If you do not name a potential mentor, we will work with you to find one.

CV/Resume

Please upload your CV or resume *

Choose File

*Please refrain from clicking the submit button again while the form is loading to avoid any duplicate submissions.
Questions can be directed to Kathryn Kietzman, project director, at kietzman@ucla.edu

Thank you for submitting your application for the Health Equity Challenge!

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