2024-2025 Visiting Professor Host Application

Question Title

* 1. Please complete the following information for your program.

Name of program

City

State

Local Arrangement Chair (Must be ASPS member)

Contact, if other than Chair

Telephone

Fax (list N/A if no fax)

Email

Question Title

* 2. Please select your 1st choice for the Visiting Professor you would like to host.

Question Title

* 3. Please select your 2nd choice for the Visiting Professor you would like to host.

Question Title

* 4. Please select your 3rd choice for the Visiting Professor you would like to host.

Question Title

* 5. Please select your 4th choice for the Visiting Professor you would like to host.

Question Title

* 6. Please select your 5th choice for the Visiting Professor you would like to host.

Question Title

* 7. Please select your 6th choice for the Visiting Professor you would like to host.

Question Title

* 8. Please select your 7th choice for the Visiting Professor you would like to host.

Question Title

* 9. Please select your 8th choice for the Visiting Professor you would like to host.

Question Title

* 10. Please select your 9th choice for the Visiting Professor you would like to host.

Question Title

* 11. Please check all visit formats that would apply to your requested visit.

Resident Lecture

Discussion Group

Patient Evaluation

Patient Rounds

Other (please specify)

Question Title

* 12. Resident Focus

Yes, the focus of the requested visit will be on residents at resident training programs.

Question Title

* 13. At this time, what format would you prefer for your visit? (This will not be your final decision and the format can be decided at a later date.)

In-Person

Virtual