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KsACEP Kansas Leadership and Advocacy Internship Application

Thank you for your interest in this Kansas ACEP program.

Note:  Upon completion of this survey portion of the application, please to email a current copy of your C.V. to awilliams@kmsonline.org.

You must also have your residency program director (residents) or department chair (for recent residency graduates) email a letter in support of your application to awilliams@kmsonline.org.
1.Applicant Name(Required.)
2.What are your career goals (including planned practice location) for the next 5 years? (200 words or less)(Required.)
3.Describe your previous experience with leadership in medicine and the specialty. (200 words or less)(Required.)
4.Why do you want to complete the Kansas Leadership and Advocacy Internship? (200 words or less)(Required.)
5.Address(Required.)
Current Progress,
0 of 5 answered
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