JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Chair Development Program (CDP)
Application Form
*Tuition is $4,750 for the course, with travel and lodging expenses paid by the participant.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Please complete the online application and email all supplemental documents to
CDP@saem.org
with "CDP Application" in subject line by July 31st.
Name (including titles/degrees):
*
Your answer
Academic Institution:
*
Your answer
Office Address:
*
Your answer
Email:
*
Your answer
Phone Number:
*
Your answer
Current Position/Title:
*
Your answer
Year(s) in Position:
*
1 Year
2 Years
3 Years
+4 Years
Academic Rank:
*
Your answer
Year(s) at Rank:
*
1 Year
2 Years
3 Years
+4 Years
If you are not currently a Chair of EM, please identify your sponsor Chair:
Your answer
Please email the following to
CDP@saem.org
:
*
Your most recent CV (Required by the CDP Program)
If you are a Chair, please submit a 1 page (max) statement of your objectives and goals as you enter the CDP.
If you are not yet a Chair, submit a 1 page maximum support letter from your Chair that includes commitment to release time to participate in the CDP and commitment for departmental funding for participation in the CDP or alternative funding plan (including travel expenses).
Required
Tentative CDP Session Dates
January 26, 2025 - Kickoff (Phoenix, AZ)
March 16, 2025 - Workshop (AACEM/AAAEM Annual Retreat)*
May 13, 2025 - SAEM Leadership Forum (SAEM25)**
June - December 2025 - Monthly Virtual Sessions
January 2026 - Closing Session
*dates are subject to change
I pledge to fully participate in the AACEM CDP and will attend all in-person sessions along with at least 90% of the scheduled virtual sessions.
*
Agree
Disagree
If you are an ADIEM and/or AWAEM member and wish to be considered for a scholarship, please indicate below and submit your letter of interest to CDP@saem.org
I wish to be considered for the AACEM/ADIEM scholarship
I wish to be considered for the AACEM/AWAEM scholarship
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Society for Academic Emergency Medicine.
Report Abuse
Forms