Applications will be reviewed by a committee to determine who would most benefit from attending the seminar. All applicants will be contacted in sufficient time to submit their materials to AAMC by their deadline.

In addition to this application, also submit your current CV and Letter of Support from your Chair, Vice Chair, or Division Chief to Kathleen.Rancourt@umassmed.edu.

1. Applying for registration funding to:

2. Name (Last, First)

3. Current Rank

4. Degree

5. Primary Department

6. Specialty

7. Are you currently working on a grant application?

8. Are you currently assembling a promotion packet?

9. Preferred Email Address

10. How do you think this seminar would contribute to your success in academic medicine? (Please limit your response to 250 words).

11. Please describe in 150 words or less your present institutional responsibilities (include Administration, Clinical Education, Research, and Other (where applicable).

In addition to this application, also submit your current CV and Letter of Support from your Chair, Vice Chair, or Division Chief to Kathleen.Rancourt@umassmed.edu.
 
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