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* 1. Full Name

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* 2. Credentials

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* 3. Name of Institution

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* 4. Email (personal email only - no institutional emails please)

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* 5. Phone Number

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* 6. Race/ethnicity: We have listed the Federal OMB Standards for race/ethnicity categories, however, we encourage you to also include your self-described identity. (select all that apply)

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* 7. Do you identify as underrepresented in medicine?

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* 8. Do you have experience developing education courses?

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* 9. Please elaborate on your experience with global health work and global health education.

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* 10. Have you attended an AAP Global Health Education Course?

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* 11. How do you see yourself contributing to the Global Health Education Course PAC? 

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* 12. What do you think is missing from current global health offerings? Does not have to be specific to AAP's programming.

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* 13. Please submit a cover letter.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 14. Please submit your CV, which includes relevant global health experience. (Limit 5 pages)

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