Apply for Mentorship

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The Award

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

First Name *
Last Name *
Institution
Applicant's Title (MD, PhD, etc)
Status: Resident, Post Residency, etc
Mailing Address *
City *
State/Province
Zip/Postal Code
Country
Email *
Proposed Mentor *
Mentor's Email
Mentor's Institution

Mentoring Program Details

Area of Focus in Contact Dermatitis
Proposed Dates of program
Location

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.

Upload your statement of purpose as a PDF or Word document.

Proposed Budget

Provide a detailed budget as a separate attachment.

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.

 

Upload budget as PDF or MS Word file
Upload letter of support from your mentor.
Upload letter of support from your program chair (if applicable).
Upload your Curriculum Vitae





Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

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