SHSSM Conference Career Panel, Session Chair & Informal Mentor Interest Form
Please only fill out this form only if you have already earned your MD/PhD. Deadline: January 2, 2019. Notification of acceptance: February 1, 2019.
Name *
Your answer
Email address *
Your answer
What is your primary field of study? *
Did you complete your MD/PhD as part of a combined program or MSTP? *
From what school(s) did you earn your MD/PhD?
Your answer
In what specialty did you complete or are you completing your residency? *
Your answer
What is your current post-graduate (PG) year?
Your answer
What is your current position? *
Your answer
Please briefly describe your current research focus, if any.
Your answer
Would you like to be a career panel participant, a session chair, or an informal mentor/lunch table discussion moderator? (Please check all that interest you). *
Required
Is it important for you to have official notice from us of your title as panelist, chair, or mentor in order to apply for travel funding from your home institution? *
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