Foundation Board Application

Personal Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Are you willing to accept text messages to the phone number provided?(Required)

Yes

Name of Employer(Required)

More About You

Personal Statement(Required)

(Include a personal statement expressing your interest, qualifications, and areas of expertise and practice. (500 word max))

AMSA Involvement(Required)

(Describe your current and previous involvement with AMSA if applicable)

Competencies & Skills(Required)

(List organizational and leadership skills, public speaking experience, & other relevant skill sets)

Community & Organizational Involvement(Required)

(List community, organizational, and other leadership activities)

How do you feel the AMSA Foundation would benefit from your involvement on the Board?(Required)

(maximum 250 words each)

AMSA is rooted in student leadership and social advocacy. What does student-led change in medicine mean to you, and how would you support and amplify the voices of future physicians through your role on the foundation board?(Required)

(maximum 250 words each)

Describe any fiduciary experience you have (could be, but not limited to practice, with your employer, with any organization or entity)(Required)

(maximum 250 words each)

Is there anything else you think would be of interest or you would like to share?(Required)

(maximum 250 words each)

AMSA Foundation Board Application

Personal Information

More About You

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