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

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) *
Please select your department(s) from the list below (Select all that apply): *
Contact Information
How do you describe your gender? *
Which of these categories describe your racial/ethnic background? (Choose all that apply): *
How did you learn about the Health Equity Challenge? (Select all that apply): *

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]

Potential Adviser/Mentor (optional)
Do you have the potential support of an academic or community adviser/mentor?

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.


*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