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2023 MED+UP Sign-Up Form

Thank you for your interest in the MED+UP program, created by the Office of Physician and APP Fulfillment. Please complete this survey to register for our 2023 program.
1. Please tell us about you: *This question is required.
2. Please select your role: *This question is required.
3. Have you participated in the MED+UP Program in the past?
4. Would you be interested in facilitating a MED+UP group in 2023? 
Do you prefer to facilitate alone or with a co-facilitator?
Do you prefer to facilitate a group that meets in person, virtually, or hybrid?
For in-person sessions, where do you prefer to meet with your group?
  • * This question is required.
  • * This question is required.
  • * This question is required.
5. What days/times would work best for you to participate in a MED+UP group? (Select one or more)
6. What is your preference for group composition? (Select 1 or more)
NOTE: We may not be able to accommodate all preferences, but we will try!