Submit your story to the Doctors with Disabilities Project
What:
The goal of the #DocsWithDisabilities/#NursesWithDisabilities Project is to share stories from the professional journeys of physicians and nurses with disabilities, in their own words. By featuring the real voices of health professionals with disabilities--including their struggles and successes--we hope to foster awareness, visibility, and community that brings together stakeholders from across medical education, clinical practice, and disability advocacy.

Who:
The project is volunteer led, by a tight-knit group of clinicians, health educators and administrators, and advocates, with and without disabilities, based at the University of Michigan Medical School's Department of Family Medicine.

Where:
Photos and stories will be posted on Twitter, using the hashtag #DocsWithDisabilities, on Instagram @docswithdisabilities, and compiled on the University of Michigan Medical School's Department of Family Medicine page.

When:
Thank you for your contribution! Submissions will be approved, processed, and posted to the above channels from January to May, 2018.

A project of the University of Michigan Medical School, Department of Family Medicine: https://medicine.umich.edu/dept/family-medicine/

Follow #DocsWithDisabilities and #NursesWithDisabilities on Twitter: http://bit.ly/docswithdisabilitiestwitter
Follow our Instagram: https://www.instagram.com/docswithdisabilities/

Email address *
Section 1: Your #DocsWithDisability Post
Only responses in THIS SECTION will be used in the public post. We will not include your email address or the information provided in Section 2.
Your full name with degrees listed *
Your Twitter handle/username or other social media/blog/personal site you would like mentioned *
Your professional affiliations, alumni institutions, and short biography *
What you want the #docswithdisabilities community to know about your experience? (in 50 words or less) *
Optional: Use this space to expand on your response! What was unique or difficult about your professional journey? What support did you get along the way? What would have made things easier?
Upload a high-quality photo of yourself (dimensions larger than 300x300 pixels if possible) *
Required
Section 2: By filling out this section of the form, you grant Michigan Medicine permission to share the information provided above in this form. This includes your full name, any affiliation provided, your photo, and social media contact provided.
The information you provide in this section WILL NOT be shared in the #docswithdisabilities campaign. It is simply required to gain consent. If you have questions or concerns, please contact us at docswithdisabilities@umich.edu
Date of Birth *
MM
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DD
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YYYY
Street address
City
State
Zip Code *
Phone Number
I give the Doctors with Disability Visibility Project at the University of Michigan Medical School permission to release the information I provided in Section 1 of this form *
The items may be released to any radio, television, internet, social media, print or other media outlet. *
Exceptions: Information may only be released according to the following guidelines:
Revoking Permission: I understand that I can revoke this permission at any time by contacting the project at docswithdisabilities@umich.edu. A copy of this form is available upon request.
Release is Voluntary: I understand this permission is voluntary. I do not have to release my information, and whatever I decide will not affect my health care and will not affect my participation in any research study.
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