Leadership Interest Form

First Name *

Last Name *

Current Position *

Med Student

Resident

Fellow

Early Career

Mid-Career

Esteemed

Institution(s) *

Email *

Areas of Interest - 1st Choice *

Enter required value Awards Committee Career Development Committee Communications Committee Resident Psychiatric Educator Award Committee Membership Committee Nominating Committee Medical Student Education Committee IDEA: Inclusivity, Diversity, Equity & Anti-Racism Committee Master Educator Committee (ME Grads Only) ANNUAL MEETING PLANNING: Educators' Showcase/Works-in-Progress (WIPs) Subcommittee ANNUAL MEETING PLANNING: Workshops Subcommittee ANNUAL MEETING PLANNING: Posters Subcommittee ANNUAL MEETING PLANNING: Media Session Subcommittee

Areas of Interest - 2nd Choice

-Select- Awards Committee Career Development Committee Communications Committee Resident Psychiatric Educator Award Committee Membership Committee Nominating Committee Medical Student Education Committee IDEA: Inclusivity, Diversity, Equity & Anti-Racism Committee Master Educator Committee (ME Grads Only) ANNUAL MEETING PLANNING: Educators' Showcase/Works-in-Progress (WIPs) Committee ANNUAL MEETING PLANNING: Workshops Committee ANNUAL MEETING PLANNING: Posters Committee ANNUAL MEETING PLANNING: Media Session Committee

Areas of Interest - 3rd Choice

-Select- Awards Committee Career Development Committee Communications Committee Resident Psychiatric Educator Award Committee Membership Committee Nominating Committee Medical Student Education Committee IDEA: Inclusivity, Diversity, Equity & Anti-Racism Committee Master Educator Committee (ME Grads Only) ANNUAL MEETING PLANNING: Educators' Showcase/Works-in-Progress (WIPs) Committee Committee ANNUAL MEETING PLANNING: Workshops Committee ANNUAL MEETING PLANNING: Posters Committee ANNUAL MEETING PLANNING: Media Session Committee