IPM faculty Application

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UofSCSOMG IPM Faculty Application

Name:*

Email:*

Terminal Degree(s):*

Prisma Health Department Affiliation:*

Which year(s) of IPM participation interests you most?*

IPM-1 IPM-2 IPM-3 IPM-4 EMT training Back up faculty to cover when my schedule allows Check All

Other: Other Value

Is your department chair or academic vice chair aware of your interest in IPM?*

Yes No

Personal Statement: Please describe what you see as strong points you bring to IPM, if applicable, highlight any career areas of teaching in medical education, and perspectives you could share in supporting greater diversity and inclusion that can contribute to a more meaningful student experience.*

Curriculum Vitae

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