Harvard Medical School OutList 2019-2020

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Thank you for joining the public list of LGBTQ faculty, residents, postdocs, trainees and staff affiliated with Harvard Medical School.

We start from scratch every year -- so please fill this out even if you have done so in the past.

**Please note: a version of this list will be publicly available (with no contact info) on Harvard websites.**

Questions? Contact Jessica Halem, LGBTQ Outreach and Engagement Director: jessica_halem@hms.harvard.edu.

Email *

First name *

Last name *

Gender Identity (check all that apply) *

Transgender

Nonbinary

Woman

Man

Other:

Required

Are you LGBTQ or an Ally? (check all that apply) *

LGBTQ

Ally (who does LGBTQ clinical care or research)

Ally (proud to have a family member who is LGBTQ)

Required

What is your Race/Ethnicity? (check all that apply)

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latinx

Native Hawaiian or Other Pacific Islander

White

Other Race/Ethnicity (please write-in)

Other:

I am a... *

Student

Faculty

Staff

Postdoc

Administrator

Fellow

Resident

Alum of HMS/HSDM

Other:

Required

Harvard Job Title *

Primary Specialty

Degree (check all that apply) *

ScD

PhD

MPH

MBA

MSW, LCSW

BA/BS

Other:

Required

HMS Primary Affiliation *

Are you engaged in LGBTQ Clinical Care or Research?

Yes

Clear selection

A copy of your responses will be emailed to the address you provided.

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