Volunteer with iTASC — Medical Student, Resident & Fellow Sign-Up Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Volunteer with iTASC — Medical Student, Resident & Fellow Sign-Up Form

iTASC — Improving Treatment Access for Skin Cancer, a nonprofit initiative dedicated to connecting underserved patients with volunteer micrographic surgeons and dermatology teams across the United States. We have successfully treated many patients in southwest Ohio and are expanding our reach across the United States.

We are developing a National Dermatology Resident/Fellow Network to expand access to life-saving skin cancer treatment for patients who lack adequate resources or insurance coverage. Our goal is to build a sustainable structure that includes many residents/fellows under one resident/fellow leader in each state and regional directors across five U.S. regions, helping to coordinate outreach, education, and partnerships with safety-net institutions.

If you are a Mohs Surgeon, please use the following form instead: https://itasc.org/surgeons/

Resident involvement may include:

• Outreach to FQHCs, county hospitals, and free clinics
• Building referral networks for underserved patients
• Awareness efforts at national meetings (AAD, ACMS, ASDS)
• Social media, education, and storytelling initiatives
• Research, data collection, and outcomes analysis

Participation is entirely voluntary and designed to be flexible around residency training and fellowship demands.

Medical Students interested in this initiative are also welcome to apply.

Thank you for your time and commitment to serving patients in need.

Full Name *

Resident/Fellow *

Resident

Fellow

Medical Student

PGY level *

PGY-1

PGY-2

PGY-3

PGY-4

PGY-5

MS-1

MS-2

MS-3

MS-4

Residency / Fellowship Program / Medical School *

Dermatology Program/ Fellowship Director Name (optional)

City *

State *

ZIP Code *

Cell Phone *

Email Address *

Are you willing to serve as the primary iTASC resident / fellow liaison for your state? *

Yes

Maybe / Need more information

Volunteer Interest Areas (Please select up to 3) *

Core Outreach : Outreach to FQHCs, county hospitals, free clinics, and university hospitals

Network Development : Recruit attending referring providers, dermatologists, and Mohs surgeons

Awareness and Events : Organize awareness events at national meetings (AAD, ACMS, ASDS), Staff booth/vendor tables at meetings, Coordinate resident/fellow meet-ups or info sessions

Communications & Media : Social media content creation, website content, patient success stories

Funding and Sponsorship : Fundraising initiatives, grant writing assistance, corporate sponsorship outreach

Research and Data : Outcomes research (insured vs underserved patients), data collection and registry development, abstract/poster development for national meetings

Education and Training : Develop iTASC educational materials for clinics

Technology and Infrastructure : GIS mapping of underserved areas

Additional Strategic Roles : Language access and cultural competency initiatives, technology support, regional leadership

Required

Will you attend quarterly virtual meetings? *

Yes

Maybe

Interest in leadership role: *

Regional Lead (for one of the five U.S. regions) – Oversees ITASC volunteer activity within a multi-state region, helps recruit and mentor State Leads, and participates in quarterly meetings with the U.S. National Leader.

State Lead for the United States Committee – Serves as the primary volunteer coordinator within a specific state and works to develop a network of county-level volunteers.

County Network Lead within a State – Helps organize volunteers and outreach efforts within a county or local area and supports the State Lead.

Project-Based Leadership – Leads or assists with a specific initiative, campaign, or short-term project without holding an ongoing geographic leadership role.

Not interested in a leadership role – Volunteers who prefer to contribute in other ways without taking on a leadership position.

Any additional ideas to expand iTASC's impact? *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of itasc.org.

Does this form look suspicious? Report

Forms