ACDS Mentoring Award Application

* = required field

ACDS mentoring awards are granted for the purpose of assisting young dermatologists including dermatology residents, dermatology fellows, or dermatologist up to 5 years out of residency to become leaders/experts in the field of contact dermatitis by acquiring additional academic skills which may not be available at their training institutions.

The applications are reviewed every 6 months on April 15 and October 15 of each year.

The Criteria

  • Either the Mentor or the Applicant must be a member of ACDS.
  • Mentor and applicant may not be from the same institution.
  • Funding may not exceed $3,000 per applicant.
  • Mentor must provide written acceptance of applicant and submit a follow-up report.
  • Academic/leadership potential is apparent, either from the applicant or department chair letters.
  • Budgeted items may include expenses related to travel and research, but may not include items as software, books, lab materials or registration fees for meetings or travel to meetings.
  • Applicant’s work is to be with one or two specific mentors, not with an entire department.

The Selection Guidelines

  • Travel expenses will be considered if it is necessary to provide a unique mentoring opportunity.
  • Preference will be given to mentors or applicants who are members of ACDS.
  • Mentoring may not serve to meet Residency Review Committee guidelines.

Requirements

  • A copy of these guidelines must accompany the application packet in order for the applicant to be aware of the selection process.
  • If an approved mentoring project cannot be completed as originally proposed, the awardee must immediately contact the ACDS office. Arrangements will be made to return the award if already received or change to an alternative project approved by the Committee.
  • 30 days prior to the start of the mentoring project, the applicant is to reaffirm the dates of the mentoring program with the ACDS Office and request their award check indicating the address for mailing.
  • Once the applicant has completed the approved project, the mentee is required to submit a written report summarizing the skills or knowledge acquired from this experience.
Applicant's Contact Information

































Mentoring Program Details

















Statement of Purpose

Describe the goal(s) of the proposed program and any specific project planned. Indicate how you envision this mentoring opportunity will impact your future in dermatology, specifically in helping you prepare to become an expert in the field of contact dermatitis.




Proposed Budget

Budgeted items may include expenses related to travel to the program and research, but may not include such items as software, books, lab materials, or registration fees for meetings or travel to meetings. Total amount should be in US dollars.







Other Information










I certify that the statements in this application are true to the best of my knowledge. I agree that the award funds will be used only for the purpose reflected in my application. Any unused funds will be returned to the ACDS. I hereby agree to provide a written progress report and financial report to the ACDS within 90 days of the termination of my mentorship program.