* 1. Name

* 2. Learner Type

* 3. E4C Applicant First Name

* 4. E4C Applicant Last Name

* 5. Please provide a paragraph of support, addressing the following for the E4C applicant:
- Describe the context of your experience with this teacher.
- Describe the teacher’s strength from the learner’s perspective. Provide an example if possible.
- Explain why this teacher would be well suited as an educator and clinical skills instructor and as a role model of compassion and advocacy for medical students.