ACLP Applc Webb Fellow 2024

1. Your contact details *This question is required.

First name
Last name
Credentials (MD, etc.)
Email

2. Your current institution *This question is required.

3. What will be your position at the time of the upcoming annual meeting (not currently)? *This question is required.

Please enter an 'other' value for this selection.

4. Are you a current member of ACLP? *This question is required.

5. Have you attended an ACLP annual meeting in the past (either in person or virtually)? *This question is required.

6. When was the most recent annual meeting you attended? *This question is required.

Please enter an 'other' value for this selection.

7. Please describe how the Webb Fellowship Program will help to advance your career in C-L psychiatry and your leadership potential. (There is a 200 word limit to your response) *This question is required.

8. Please describe a specific academic project that you hope to present at the 2024 annual meeting. This could include the methods or results of a research study, quality improvement project, review article, or other scholarly work. (There is a 200 word limit to your response) *This question is required.

9. Please describe your current involvement in the ACLP and how the Webb Fellowship Program will enhance your engagement in the ACLP. (There is a 200 word limit to your response) *This question is required.

10. Please describe your contribution(s) to the field of consultation-liaison (C-L) psychiatry through scholarly work and leadership. Scholarly work may include any work related to expanding knowledge of C-L psychiatry through education, research, quality improvement, and other activities (There is a 200 word limit to your response) *This question is required.

11. In-person attendance at the annual meeting is required of award winners. Nominations are only accepted if you can confirm that you will attend the annual meeting in person. If selected, will you attend the annual meeting in person in November? *This question is required.

12. Please upload your CV (PDF or Ms-Word only; 1MB file size limit) *This question is required.

File: {{filename}} delete

13. Please upload a portrait photo. Photos are not used in judging and only the photos of award recipients are used for annual meeting program presentation purposes. Accepted file formats: png, gif, jpg, jpeg; max file size 1MB *This question is required.

File: {{filename}} delete

14. Please provide a 150-word bio in a format that could be referenced in advertising or read aloud when introducing you as an award winner at the annual meeting. This information will not be used in the judging process. *This question is required.

15. Please provide the phonetic spelling of your name

There are no further questions. Click Submit to file your application. Thank you.

ACLP Applc Webb Fellow 2024

Webb Fellow Program Application