Registration June 16, JEP

Registration

Judicial Education Program

Educating the Judiciary about the Social Determinants of Health (SDOH)

Friday, November 3, 2023

Venue: Northeastern University

First Name

Last Name

Email

Phone

What is your current job/professional title?

What agency/court do you currently work for?

What state do you primarily work in?

If you answered "Other" above, please specify here.

Years in current position?

0-5

6-10

11-15

16+

If you answered "Other" above, please specify here.

Have you attended other trainings on law topics related to the social determinants of health (mental health, violence & abuse, poverty, aging, neighborhood safety, education, health behaviors, housing, job & income, access to clinical care, access to childcare, or infrastructure & transportation)? If so, please name the organization that hosted the training & the content covered.

If you answered "Other" above, please specify here.

What is your gender identity?

If you answered "Other" above, please specify here.

How would you describe your racial identity? (Check all that apply)

How would you describe your ethnicity?

Hispanic or Latino

Not Hispanic or Latino

Will you be requesting CLE/CJE credits for this program?

Yes

No

Other

If yes, please specify the state/jurisdiction for which you would like CLE/CJE credits.

Will you need travel and hotel accommodations?

Yes

No

Please let us know below if you have any dietary restrictions.