VAFP Student Election Information

Student Candidate Information

Question Title

* 1. Contact Information

First

Middle Initial

Last

Email Address

Phone Number

Question Title

* 2. Medical School Name

Question Title

* 3. Medical School Year

M1

M2

M3

M4

Question Title

* 4. Personal Statement (please include why you are interested in the position, past experiences, skills, etc.) - 250 word maximum. This will appear exactly as written.

Please email your photo to ML White (mlwhite@vafp.org)
at the VAFP Headquarters office.