AACEM/AWAEM Chair Development Program Scholarship and Application for 2020-2021

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AACEM/AWAEM will award one scholarship winner the cost of CDP Tuition ($4,200) and an additional travel stipend ($2,500).

Please complete the online application and email all supplemental documents to AWAEM@saem.org by Monday, September 30, 2019.

Name: *

Jane Smith, MD

Academic Institution: *

University of Iowa Hospitals and Clinics

Office Address: *

1111 E Touhy Ave. Suite 540, Des Plaines, IL 60018

Email: *

Phone Number: *

Current Position/Title *

Year(s) in Position *

1 Year

2 Years

3 Years

4+ Years

Academic Rank *

Year(s) at Rank: *

1 Year

2 Years

3 Years

4+ Years

If you are not currently a Chair of EM, please identify your sponsoring Chair:

Please email the following to AWAEM@saem.org:

Your most recent CV (Required by CDP)

A one-page personal statement on why you are qualified for the scholarship. Include narrative on your leadership, scholarship, mentorship and management experience

If you are not yet a Chair, submit a 1 page maximum support letter from your Chair that includes a nomination for scholarship and a commitment to release time to participate in CDP

Tentative CDP Session Dates:

I pledge fully to participate in the AACEM CDP & will attend at least 4 of the 5 sessions, including the first and last session of the program. *

Agree

Disagree

I agree to the following:

If I am not selected for the AACEM/AWAEM Chair Development Program Scholarship, I would still like my application to be considered for CDP enrollment. I have departmental commitment to funding my participation in the CDP or I have an alternative funding plan (including travel expenses)

If I am selected for the AACEM/AWAEM Scholarship, I will be required to: Write a column for SAEM Pulse about the experience, and present a summary of my experience to the AWAEM Executive Committee via conference call or at the annual business meeting (by teleconference, webinar or in-person)

Submit

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