Department of Medicine Social Media Request Form
Use this form to request a content campaign that you would like to appear on UW-Madison Department of Medicine (DOM) social media account(s). Content campaigns involve a series of posts/tweets over weeks to months to raise awareness of a specific topic or DOM program. If you are interested in submitting a brief, one-time social media request, do not use this form; instead, email your request directly to

Requests are subject to approval by administrative leadership. Where appropriate, DOM communications staff (Robyn Perrin) can consult with you about social media strategy and will work with social media managers of other UW-Madison, School of Medicine and Public Health, and UW Health social accounts in an effort to reach a broader audience.

DOM social media accounts:
ForMD (a closed online community for graduates of Department of Medicine residency and fellowship programs)

Requestor Information
Name: *
Your answer
Role: *
Your answer
Email address: *
Your answer
Additional contributors:
If you intend to have multiple authors and/or moderators of this content, please list their names and roles below:
Your answer
Project name: *
Your answer
Objectives: *
Please describe what you would like to accomplish with this social media campaign, and how you will measure success.
Your answer
Alignment with department mission, vision, and values: *
Indicate briefly how this project aligns with the Department of Medicine's mission, vision, and values. (Mission: to advance the health of the people of Wisconsin and beyond through high-quality, patient-centered care, innovative research, and education of the next generation of physicians. Vision: High-quality patient-centered care; transformational research; and innovative education programs. Values: Professionalism, Patient-Centeredness, Compassion, Excellence and Innovation, Diversity, Teamwork, Scholarship, and Stewardship of our resources.)
Your answer
Social media platforms (check all that apply): *
Audience (check all that apply): *
When would you like this social media campaign to begin and end?
Your answer
Will this campaign require paid social media advertising? *
If paid advertising is required, what is your budget for the campaign?
Your answer
Faculty member supporting/requesting this project: *
Your answer
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