Military Personnel Database Outreach

Dear faculty, staff and students,

BU Military Center invites you to participate in our effort to develop a database of Boston University faculty, staff and students with military background for the following goals –

Foster mentorship opportunity between faculty and students with military background
Provide a platform for military networking opportunities within BU community
Attract attention of investigators from within this group towards research areas in the military health
Increase awareness among this group about all ongoing military health research at BU/BUMC and facilitate potential participation opportunities

This is a confidential database primarily intended for updating you to current events in military health research. If interested to participate, please fill out the following form. Contact Lizette Mendez for further inquiries.

Thank you for your participation!

BU/BUSM Military and Veteran Database Registration Form

Name
First Last
Age (years)
Gender:
- Male
- Female
- Prefer Not to Answer
Current status in the BU/BUSM
- Faculty/Staff
- Student
Current status in the military
- Active
- Veteran
Branch in the military
- Army
- Marine Corps
- Navy
- Air Force
- Coast Guard
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Information
Email Address Phone (Cell) Phone (Work)
Date form was completed
MM slash DD slash YYYY
CAPTCHA

Email Address	Phone (Cell)	Phone (Work)