CoSEF New Member Intake

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Please provide the following information for CoSEF leadership to review in consideration of your CoSEF membership request. The following questions are aimed to help CoSEF confirm your passion and interest in Surgical Education, which is the main requirement for membership.

Of note, CoSEF membership is open to all interested post-graduate surgical trainees (residents and fellows) but is not open to medical students or attendings at this time.

Full Name *

Permanent Email Address: *

Cell Phone Number: *

What institution are you completing clinical residency at? *

What institution are you completing dedicated research time at? (If Applicable)

Current PGY-Level: *

Clinical PGY1

Clinical PGY2

Clinical PGY3

Clinical PGY4

Clinical PGY5

Research Resident Year 1

Research Resident Year 2

Research Resident Year 3

Completing Clinical Fellowship

Other:

Are you currently taking dedicated research or development time during residency to pursue training in surgical education? *

Yes

Other:

Are you planning to take dedicated research or development time during residency to pursue training in surgical education? *

Yes

Other:

Have you already completed dedicated research or development time focused on surgical education? *

Yes

Other:

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