2024 ENRICH Trainee Application

Please complete and submit the form below.

If you have questions, please contact Eve Phillips at UABENRICH@uabmc.edu.

ENRICH Trainee Application – 2024

Please provide your legal name *

Please provide your legal name

First

Middle

Last

Please provide your UAB/Samford email address *

Current mailing address *

City *

State *

Zip code *

Phone number (example: (XXX) XXX-XXXX) *

Citizenship *

United States Citizen

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Gender Identity *

Race *

Are you Hispanic or Latino? *

Yes

No

Do you have a disability? *

Yes

No

Do not wish to provide

Are you from a disadvantaged background? *

Yes

No

Do not wish to provide

Undergraduate Institution Name *

Institution City/State *

Degree conferred *

BA

BS

OtherOther

Graduation Date (MM/DD/YYYY) *

Current Degree Program * Current Degree Program

Current Institution (UAB or Samford?) *

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UAB is an Equal Employment/Equal Educational Opportunity Institution dedicated to providing equal opportunities and equal access to all individuals regardless of race, color, religion, ethnic or national origin, sex (including pregnancy), genetic information, age, disability, religion, sexual orientation, gender identity, gender expression, and veteran’s status. As required by Title IX, UAB prohibits sex discrimination in any education program or activity that it operates. Individuals may report concerns or questions to UAB’s Assistant Vice President and Senior Title IX Coordinator. The Title IX notice of nondiscrimination is located at uab.edu/titleix.