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Create a new PHTC account

Use the following form to create a new account to access PHTC modules.

Username

E-mail

Password

Password (again)

First Name

Last Name

Select your age group

Please Select Under 20 Years 20-29 Years 30-39 Years 40-49 Years 50-59 Years 60-69 Years 70 Years or Older I prefer not to answer

Select your gender.

Please Select Male Female

Are you of Hispanic. Latino, or Spanish origin?

Please Select Yes No I prefer not to answer

Select the option(s) which best represents your race (select all that apply)

Please Select American Indian or Alaskan Native Asian (including Chinese, Filipino, Japanese, Korean, Asian Indian, or Thai) Asian (other) Black or African-American Native Hawaiian or Pacific Islander White More Than One Race Other I prefer not to answer

Select the highest degree earned.

Please Select High school/GED Associate degree Bachelors degree Masters Degree Doctoral degree or equivalent

Work City

Work State

Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Work Zip Code

Which of the following categories best describes your primary discipline/specialty?

Please Select Biostatistics Behavioral Health |Social Work Behavioral Health |Psychology Behavioral Health - Substance use/Addiction Counseling Community Health Worker Dentistry Emergency management/emergency preparedness Environmental Health - Environmental chemistry Environmental Health - Environmental health planning Environmental Health - Environmental sciences Environmental Health - Industrial hygiene Environmental Health - Occupational safety and health Environmental Health - Radiological health Environmental Health - Toxicology Environmental Health - Water quality Epidemiology EMT-Paramedic/First responder Geriatrics/Aging Populations Global/International Health - Tropical medicine Health education/behavior - Behavioral sciences Health education/behavior - Community health sciences Health education/behavior - Evaluation research Health education/behavior - Health behavior Health education/behavior - Health promotion/disease prevention Health Policy/Law Health Services Research Health Services/Hospital Administration Health Services/Hospital Administration - Health management Health Services/Hospital Administration - Health planning Health Services/Hospital Administration - Hospital administration Maternal & Child Health - Adolescent health Maternal & Child Health - Infant and child health Maternal & Child Health - Womens health Medicine - Physician Medicine - Physician Assistant Nutrition - Dietetics Nutrition - Public health nutrition Nursing - Advanced nurse specialist Nursing - Home health aide Nursing - Nurse Practitioner (NP) Nursing - Patient Care Associate (PCA) Nursing - Registered nurse (RN) Nursing - Occupational Health Pharmacy Public Health (general studies) Public Health Practice - Community health practice Public Health Practice - Program management Support staff Urban Health Other

Please Specify

Which category best describes your employment location?

Please Select Academia Federal government State government City/County government Indian Health/Tribal government Hospitals Community-based Organizations/Non-profit Private Industry Other

Please Specify

Do you work in a department of public health?

Please Select Yes No I do not know

Do you work in a health department within our target geographic area?

Please Select Putnam County (NY) Westchester County (NY) Nassau County (NY) Suffolk County (NY) New York City (NY) I do not work in any of the health departments listed

How many years have you worked in public health?

Please Select 0-5 6-10 11-15 16-20 21-25 25+ I do not work in public health

Do you work in a medically underserved community (MUC)?

Please Select Yes No I do not know

Do you work in a rural setting?

Please Select Yes No I do not know