2026 BCPH 40 under 40 Form

BCPH WORLD 40 UNDER 40 PUBLIC HEALTH CATALYST & HEALTH INNOVATORS TO WATCH AWARDS

PITCH YOUR GREATNESS
Please note that while you do NOT have to be a member to apply for these awards, you must have an active membership in order to receive the award: https://bcph.org/membership/.

The Awards are for the BCPH community.

NOTE THAT IN ADDITION TO THIS APPLICATION YOU MUST PITCH ON THE RESPECTIVE DATE IN A VIRTUAL WEBINAR.

The 3 min Pitch included WHY YOU SHOULD WIN THE AWARD.
I am applying for the following and will PITCH on the following date. Choose ONE ONLY. You must have lived within a continent for 12 months from 2020 to 2026 to apply for a given award. Zoom link will be sent for PITCH WEBINAR.

40 Under 40 - AFRICA Continent (Due BEFORE PITCH March 7, 2026)40 Under 40 - NORTH AMERICA(Canada, U.S., and Mexico) (Due BEFORE PITCH March 14, 2026)40 Under 40 - EUROPE (Due BEFORE PITCH March 21, 2026)40 Under 40 - ASIA AND AUSTRALASIA (Due BEFORE PITCH June 13, 2026)40 Under 40 - CENTRAL AND SOUTH AMERICA (Due BEFORE PITCH July 11, 2026)
Primary Email*
example@example.com
Secondary Email*
example@example.com
Name*

First NameLast Name
Pronouns*
Example: She/Her/Hers
State (if applicable)
Postal code search
Country of Residence (at time of application)*
Country of Origin*
Title*

MD/DOScD/SD/DScPhDJDMAMS/MPHOther
Mobile Number for SMS
Current Professional Position(s) (e.g., Student, Professor)*
Organizational Affiliation(s)*
Area(s) of public health/health and social justice focus (Select all that apply.):*

Health policyHealth managementMaternal and Child HealthReproductive and sexual healthLGBTQ+ HealthMen's HealthWomen's HealthSubstance Use, Abuse, and AddictionRefugee/Immigrant HealthInfectious diseasesEnvironmental healthOccupational healthDental HealthGlobal HealthDisabilityOther
Professional Biography (no more than 10 sentences MAX)*
Upload CV*

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Upload Professional Headshot*

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LinkedIn URL*
Other relevant links and information (Social media channels, personal professional website):
Are you a member of the Boston Congress of Public Health? You may apply without a membership, but if awarded the fellowship, a membership must be purchased. More information: https://bcph.org/membership/.*

YesNo, but I'd like to learn more and apply here: https://bcph.org/membership.
Demographics

Below are some background questions that help us tailor our programming. You are not obligated to answer.
Gender: I identify as (click all that apply):

ManWomanNon-BinaryTrans genderXOther
Race: I identify as (click all that apply):

WhiteBlack or African AmericanAsianAmerican Indian and Alaska NativeNative Hawaiian and Other Pacific IslanderOther
I am /was the first person in my family to go to college.
Age

Under Age 1818-2122-2526-2930-3435-3940-4445-4950-5455-5960+
Please verify that you are human*
Payment

Registration Payment (Please select correct payment or application will be INVALID)*

40 Under 40 App Fee - Africa

$15.00

40 Under 40 App Fee - North America, Central/South America, Europe, Asia/AustralAsia

$35.00

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Total

$0.00

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BCPH WORLD 40 UNDER 40 PUBLIC HEALTH CATALYST & HEALTH INNOVATORS TO WATCH AWARDS

Demographics

Payment