ACR/EULAR Research Exchange Program 2023

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* 1. Are you an ACR/ARP Member? (Yes/No)

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* 2. ACR/ARP Member Number?

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* 3. Last Name

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* 4. First Name

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* 5. Email Address

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* 6. Institution

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* 7. Program Type

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* 8. Address (include City, State and Zip Code)

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* 9. Work Phone (+1-XXX-XXX-XXXX)

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* 10. Are you a US Citizen? (Yes/No)

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* 11. Are you a Permanent U.S. Resident? (Yes/No)

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* 12. If not U.S. Citizen, indicate country of citizenship:

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* 13. If not U.S. Citizen, indicate visa type

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* 14. Do you have a Valid Passport? (Yes/No)

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* 15. Passport Expiration date.

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* 16. Are you fluent in any other languages? (Please list languages)

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* 17. Academic Rank/Title (e.g. Assistant Professor. etc.)

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* 18. Year Awarded Academic Rank/Title

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* 19. Faculty Status (part-time, full-time)

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* 20. Tenured (Yes/No)

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* 21. Board Certification/Doctoral Level Degree.

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* 22. Do you have a research mentor?

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* 23. Current curriculum vitae (NIH format - limited to 5 pages - please include publications)

Please upload a copy of your CV

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 24. Personal statement

Please upload a personal statement outlining how participation in the 2023 ACR/EULAR Research Exchange program will benefit your research career; how you can contribute to the program and your commitment to academic and clinical rheumatology.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 25. Letter of recommendation from a senior academician within rheumatology.

Please upload 1 letter of recommendation from a senior academician within rheumatology.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 26. Letter of support from Chief of Rheumatology

Please upload 1 letter of support from Chief of Rheumatology

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

ACR/EULAR Research Exchange Program 2023

Question Title

* 1. Are you an ACR/ARP Member? (Yes/No)

Question Title

* 2. ACR/ARP Member Number?

Question Title

* 3. Last Name

Question Title

* 4. First Name

Question Title

* 5. Email Address

Question Title

* 6. Institution

Question Title

* 7. Program Type

Question Title

* 8. Address (include City, State and Zip Code)

Question Title

* 9. Work Phone (+1-XXX-XXX-XXXX)

Question Title

* 10. Are you a US Citizen? (Yes/No)

Question Title

* 11. Are you a Permanent U.S. Resident? (Yes/No)

Question Title

* 12. If not U.S. Citizen, indicate country of citizenship:

Question Title

* 13. If not U.S. Citizen, indicate visa type

Question Title

* 14. Do you have a Valid Passport? (Yes/No)

Question Title

* 15. Passport Expiration date.

Question Title

* 16. Are you fluent in any other languages? (Please list languages)

Question Title

* 17. Academic Rank/Title (e.g. Assistant Professor. etc.)

Question Title

* 18. Year Awarded Academic Rank/Title

Question Title

* 19. Faculty Status (part-time, full-time)

Question Title

* 20. Tenured (Yes/No)

Question Title

* 21. Board Certification/Doctoral Level Degree.

Question Title

* 22. Do you have a research mentor?

Question Title

* 23. Current curriculum vitae (NIH format - limited to 5 pages - please include publications)

Question Title

* 24. Personal statement

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* 25. Letter of recommendation from a senior academician within rheumatology.

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* 26. Letter of support from Chief of Rheumatology

* 23. Current curriculum vitae (NIH format - limited to 5 pages - please include publications)