2024 Application for Medical Student Scholars for Health Equity in Myeloma

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Email *

Full Name *

What is your mailing address? *

What is your email address? *

What is your phone number? *

Which medical school do you currently attend? *

What year of medical school are you in currently? *

Please select your race and ethnicity:

Hispanic/ Latino

Black or African American

American Indian/ Alaska Native

Asian American

Native Hawaiian or other Pacific Islander

White

Are you currently a dues-paying member of the Student National Medical Association? *

Yes

If yes, please provide your membership number. *

In 500 words or less, please explain why you would like to participate in this program.

Is there anything else you would like us to know? (100 words or less)

Please confirm that you have emailed your CV/resume to the following email - cstephens@thecobbinstitute.org. Applications will not be reviewed unless there is a CV/resume to match the application. *

Yes

Send me a copy of my responses.

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