Mr. Mrs. Ms. Dr. Male Female Other Prefer Not to Answer DO Student MD Student DO-PhD Student MD-PhD Student PhD Student Undergraduate Student / Post-Bac Resident / Fellow Post-Doc Training Program Director / Administrator Faculty / Professor Other Undergraduate Year 1 Undergraduate Year 2 Undergraduate Year 3 Undergraduate Year 4 Undergraduate Year 5 Medical School-Year 1 Medical School-Year 2 Medical School-Year 3 Medical School-Year 4 Graduate School-Year 1 Graduate School-Year 2 Graduate School-Year 3 Graduate School-Year 4 Graduate School-Year 5 Graduate School-Year 6+ Internship Residency Fellowship Post-Doctoral Research Not Applicable Yes No Yes No American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Prefer Not to Answer Hispanic or Latino/a Not Hispanic or Latino/a Prefer Not to Answer Executive Council Position
Please indicate if you are interested in an Executive Council position. Note that some positions are elected and others are appointed, as indicated.
President-Elect Vice President Events Committee Chair Fundraising Committee Chair Membership Committee Chair Partnerships Committee Chair Policy Committee Chair Public Relations Committee Chair Technology Committee Chair Member-At-Large (MD-PhD, DO-PhD) Member-At-Large (MD, DO) Member-At-Large (Social Sciences and Humanities) Resident Liaison Events Vice-chair Fundraising Vice-chair Membership Vice-chair Partnerships Vice-chair Policy Vice-chair Public Relations Vice-chair Technology Vice-chair Undergraduate Liaison Vice-chair Institutional Representatives, Standing Committees, and Ad Hoc Committees
Please indicate if you would like to be an Institutional Representative, serve on a Standing Committees, and/or participate in an Ad Hoc Committees. Ad Hoc Committee descriptions can be found http://www.physicianscientists.org/?page=AdHocCommittees
Albert Einstein/Yeshiva University Augusta University/Medical College of Georgia Boston University Brown University Case Western Reserve University Medical School Chicago Medical School - Rosalind Franklin University of Medicine and Science Cleveland Clinic Lerner College of Medicine (CCLCM) Columbia University Dartmouth College Doris Duke Clinical Research Mentorship Program Drexel University Duke Medical School Emory University George Washington University Georgetown University Harvard Med School/MIT Joint Program - Health Science and Technology Program (HST) (MD/PhD) Harvard Medical School New Pathway Program (MD-PhD) Howard Hughes Medical Institute (HHMI) Indiana University - Purdue University Indianapolis Johns Hopkins University Louisiana State University Health Sciences Center - New Orleans Louisiana State University Health Sciences Center - Shreveport Loyola University Chicago Massachusetts Institute of Technology Mayo Graduate School Medical College of Wisconsin Medical University of South Carolina Michigan State University College of Osteopathic Medicine (MSUCOM) (DO program) Michigan State University DO-PhD Program Michigan State University MD-PhD Program Mount Sinai School of Medicine National Institutes of Health Medical Research Scholars Program New York Medical College Northeast Ohio Medical University (NEOMED) Northwestern University Ohio State University, The Oregon Health & Science University Penn State College of Medicine Rosalind Franklin University of Medicine and Science Saint Louis University Sarnoff Fellowship Program SUNY Buffalo - State University of New York - Buffalo SUNY Downstate SUNY Stony Brook SUNY Upstate Medical University Temple University Texas A&M University Health Science Center College of Medicine Texas Tech University Tulane University University of Alabama - Birmingham (UAB) University of Alaska, Anchorage (UAA) University of Arkansas for Medical Sciences University of Buffalo School of Medicine University of California - Davis (UC Davis) University of Central Florida University of Chicago University of Cincinnati College of Medicine University of Colorado Health Sciences Center University of Connecticut University of Florida University of Illinois - Chicago University of Illinois - Urbana-Champaign University of Iowa University of Kansas Medical Center University of Kentucky University of Louisville University of Massachusetts Medical School University of Medicine & Dentistry of New Jersey (Osteopathic) University of Miami University of Michigan University of Minnesota-Minneapolis School of Medicine University of Mississippi School of Medicine University of Nebraska University of Nevada, Reno University of New Mexico University of North Carolina - Chapel Hill University of Pennsylvania University of Pittsburgh University of Rochester University of South Alabama University of South Dakota - Sanford School of Medicine University of Southern California - Cal Tech University of Texas Health Science Center - Houston University of Texas Health Science Center, San Antonio University of Texas Medical Branch, Galveston School of Medicine University of Texas, Austin University of Toledo School of Medicine University of Utah University of Virginia University of Washington Vanderbilt University Virginia Commonwealth University Washington University (St. Louis, MO) Weill Cornell Medical College West Virginia School of Osteopathic Medicine West Virginia University Wright State University Yale University Universidad Central del Caribe Other (Please specify) Membership Committee Policy Committee Public Relations Committee Partnerships Committee Events Committee Technology Committee Fundraising Committee Membership Committee Policy Committee Public Relations Committee Partnerships Committee Events Committee Technology Committee Fundraising Committee Association for Clinical and Translational Science (ACTS) Partnership Interactive Sessions Mentorship Program in-Training Collaboration Medstro Databases Clinical Transition Study Guides Physician Scientist Trainee Diversity Working Group (PST-DWG) Association for Clinical and Translational Science (ACTS) Partnership Interactive Sessions Mentorship Program in-Training Collaboration Medstro Databases Clinical Transition Study Guides Physician Scientist Trainee Diversity Working Group (PST-DWG) Association for Clinical and Translational Science (ACTS) Partnership Interactive Sessions Mentorship Program in-Training Collaboration Medstro Databases Clinical Transition Study Guides Physician Scientist Trainee Diversity Working Group (PST-DWG) Candidate Personal Statement
Please indicate below your prior involvement with APSA (as a member or leader), and your motivations for wanting to serve as an APSA leader. You can also use this space to indicate any information you haven't included elsewhere in the application. This can be short (1-2 paragraphs).