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.
What is your primary field of study?
Did you complete your MD/PhD as part of a combined program or MSTP?
No, I completed the MD and PhD separately
From what school(s) did you earn your MD/PhD?
In what specialty did you complete or are you completing your residency?
What is your current post-graduate (PG) year?
What is your current position?
Please briefly describe your current research focus, if any.
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).
Career panel participant
Informal mentor or lunch table discussion moderator
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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