Application

First Name *
Last Name *
Residency Program *
Contact Information
Email *
Phone Number *
What is your purpose for participating in the Rural GME Leadership Academy? *
Years teaching in UME?
Years teaching in GME?
It is expected that participants attend and participate in all sessions in order to gain the knowledge and comfort level necessary to be a successful leader.
Confirm Commitment *
Yes. I am committed to attending ALL sessions in order to gain the skills necessary to become an effective rural medical educator and leader.
Applicants will be notified of their acceptance on or before December 19^th, 2022.