First Name*

Last Name*

Degree*

Department/Division *

Rank*

Email*

Ethnicity (Mark all that Apply)*

African American or Black	Asian
Hispanic/Latino	Native American/Alaska Native
Native Hawaiian or Pacific Islander	White

Gender*

Please select one (1) PI 3 Meeting for your first choice date. The number of attendees is limited per meeting and you are not confirmed until you receive an e-mail with the meeting Zoom link or location.

1/22/2019, 12-1pm

3/21/2019, 12-1pm

4/18/2019, 12-1pm

6/20/2019, 12-1pm

11/19/2019, 12-1pm

1/24/2020, 12-1pm

2/27/2020, 12-1pm

7/24/2020, 12-1pm

10/25/2021, 2-3pm

Please select one (1) PI 3 Meeting for your second choice date. The number of attendees is limited per meeting and you are not confirmed until you receive an e-mail with the meeting Zoom link or location.