The Faculty of Color Network (FCoN) encourages professional interaction and the exchange of information among underrepresented minority faculty throughout the Mount Sinai Health System. The FCoN database is intended to serve as a resource for leadership and pipeline development through mentoring, support and service between faculty, trainees, and medical and graduate students of color.

If you currently hold a faculty position in the Mount Sinai Health System (which includes the Icahn School of Medicine at Mount Sinai, all hospital campuses, and affiliated ambulatory locations), please complete the following intake form to become listed in the FCoN database. The items marked with an asterisk (*) are required.

Please note: All of the information you provide on the form below will be searchable by other Mount Sinai Health System faculty and students. Contact the Office for Diversity and Inclusion at diversity@mountsinai.org or 646-605-8280 with comments or questions.


Faculty Info

*Last Name *First Name
*Primary Degree Primary Degree (Other)
Secondary Degree Secondary Degree (Other)
Demographics

What is your current gender identity? Additional gender category (or Other) – please specify
What is your self-identified race?
Other Asian or Pacific Islander – please specify Other self-identified race – please specify
Are you of Hispanic, Latino, or Spanish origin?
Other Hispanic, Latino, or Spanish origin – please specify
*Languages Spoken (Select all that apply)


























Languages Spoken (Other)
Do you think of yourself as Other sexual orientation – please describe
Faculty Prof. Info

*Faculty Rank Faculty Rank (Other)
*Faculty Status Faculty Status (Other)
*Primary Site (Where over 50% of time is spent) Primary Site (Affiliated Off-site Faculty Practice or Private Practice Address)
Secondary Site Secondary Site (Affiliated Off-site Faculty Practice or Private Practice Address)
*Department/Specialty

















































Department/Specialty (Other)
*Type of Work













Type of Work (Other)
*Does your work involve a focus on minority health and/or health disparities
Professional Interests

Mentoring Interests









Mentor Interest (Other)
Areas I am personally interested in developing a network around









Specify Other Areas
Contact Info

* Office Phone Number
Office Fax Number
* Preferred E-mail for Professional Communication
*Preferred Address for Professional Communication
General Information

Is there any additional information you would like to share? (400 char max)

 
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