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Joseph E. Johnson Leadership Day Grant Application

Note: This application is for young physician, Associate, and medical student members to apply for travel grants for Leadership Day 2012. Fields marked with * are required.

* Member's Name:

* ACP Chapter:

* ACP Number:

* Address:

* Phone Number:

* Email:

Are you a member of the ACP Advocates for Internal Medicine Network?

Yes
No

In 250 words or less, please describe your interests in healthcare policy advocacy, as well as any previous involvement in ACP’s advocacy efforts and/or chapter activities. Please note that your statement will be reviewed in a blinded process. All identifying factors such as your name, the names of others, locations, or addresses, will be deleted before your statement is reviewed by the proper member constituent council (i.e., the Council of Young Physicians, Council of Associates or Council of Student Members).

 

Applications must be submitted by February 15, 2012.

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