VAFP 2018 Resident Election Information

Candidate Information

Question Title

* 1. Contact Information

First

Middle Initial

Last

Suffix (MD/DO)

Email Address

Phone Number

Question Title

* 2. Residency Program Name

Question Title

* 3. Residency Year

Completing First Year

Completing Second Year

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 Matt Schulte (mschulte@vafp.org)
at the VAFP Headquarters office.