Directory Registration


*Response Required
Individual Profile
*
*
*
*
   
*
*
Username and password must be at least 6 characters long. Letters, numbers, and symbols may be used. Not case sensitive.
*

Work Address

 
*
*
*       

Additional Information
 
*Position The system allows a person to be listed with multiple positions if appropriate. Check all the positions below that apply.
Your entry will be validated by the administrator at your site.
 
 
Leadership
   
   
   
   
   
   
   
   
   
   
 
 

Type each position on a separate line
 
Primary Activity Coordinators
   
   
   
   
   
   
   
   
   
 
 
Discipline Coordinators
   
   
   
   
   
   
   
   
   
   
   
   
   
 
 

Type each position on a separate line
 

Type each position on a separate line
 
 
*Primary Discipline:
(Included in DGIS export)
Discipline(s):
(Check all that apply)
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
 
*AUCD Council Membership
(Check all that apply)
Checking/unchecking membership adds/removes member from council listservs.

Professional Areas of Interest and Expertise
Provide a list of "key words", separated by commas, rather than complete sentences; 200 words or less for each.

200 words or less

200 words or less

200 words or less

Copy & Paste
Vita or Bio

200 words or less

Photo should be at most 250 (width) x 300 (height) pixels.
File size must be under 35KB.

Additional Information
 
*Check if you are a
   
   
   
*Gender
 
 
Not affiliated with MCH Leadership Training Program
*Race
refers to people having origins in any of the original peoples of Europe, the Middle East, or North Africa.
refers to people having origins in any of the Black racial groups of Africa.
refers to people having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
refers to people having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent (e.g. Asian Indian).
refers to people having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
includes individuals who identify with two or more racial designations.
is included for individuals who are unable to identify with the categories
* Hispanic is an ethnic category for people whose origins are in the Spanish-speaking countries of Latin America or who identify with a Spanish-speaking culture. Individuals who are Hispanic may be of any race.
 
*PRIMARY Employment
Role at Program
 
 
 
 
 
 
*Personal relationship
with Disabilities

(Check all that apply)
   
   
   
   
   
   
   
   
Subscription
to AUCD
Listservs

Check / Uncheck to manage member subscriptions to the following AUCD listservs available to all network members: