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* 1. Please provide the following information:

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* 2. URL of department website:

Indicate if you are willing to serve as a site sponsor for the clinical (MSSCE), research (RREMS) or both programs in 2020. You may select either one or both of the programs.

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* 3. Program Selection

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* 4. We are willing to host the following number of students for 2020:

Provide the Name(s) and Academic Position(s) of proposed mentors.

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* 5. MSSCE Mentors:

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* 6. RREMS Mentors:

Questions 7 & 8 should be answered by RREMS Sites Only.

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* 7. Describe current research efforts/opportunities that may be applicable for a summer externship project.

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* 8. If a student at your site receives a score that is recommended for funding but does not score within the payline, they may be accepted into the RREMS program, but will not receive a stipend.

If this occurs, is your institution willing to host the student for the summer and provide funding to cover registration and travel to the AAP meeting for them to present their work?

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* 9. We agree to support all travel, hotel and registration costs to the 2021 AAAP meeting for student(s) placed at our site.

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