OPERATION BUSHMASTER - FACULTY APPLICATION
Complete this form if you are interested in serving as a faculty member for the Spring 2021 Operation Bushmaster.  

Responses will be submitted directly to the Course Director

Lt Col Leslie Vojta
leslie.vojta@usuhs.edu
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Please provide your name and contact information:
Name (Last, First) *
Rank, Service *
Medical Specialty *
Email address *
Where you PREFER to receive Bushmaster correspondence.
Phone (cell) *
Where will your travel to Bushmaster originate (example - in the National Capital Region)? *
Organization
What is your parent command, organization, or institution?
Interest and Availability
You must report to Ft Indiantown Gap, PA by 1000 on Day 1.  You will be released by 1400 on Day 3.
Please indicate your Areas of Interest (check all that apply): *
Required
Please indicate your First Choice iteration *
Please indicate your Second Choice iteration *
Would you be willing to serve for two iterations?  If so, please check which two you would like to attend.
Clear selection
Will you be able to travel to Ft Indiantown Gap, PA by POV (instead of commercial travel)?
Clear selection
I plan to attend faculty training on 21 April and I would prefer that training occur
Clear selection
Bushmaster Experience
Please indicate your most recent experience with Bushmaster
Previous faculty and staff positions *
Please indicate which positions you have served in previously in support of Operation Bushmaster or other USU Medical Field Practica (check all that apply):
Required
Please provide a brief description of your relevant experience (operational and educational)  below.   *
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