2022 Chapter Directory - Official LMSA National

LMSA National Chapter Directory Form

Dear LMSA Chapter: The information collected will help LMSA National build and strengthen our national network of support for Hispanic, Latina/o/x trainees. The survey takes approximately 5-10 minutes. If you have any questions please email LMSA CDO Santos Acosta or Deputy CDO Natalie Calderon at membership@lmsa.net.
Full Institution Name *
(Please write out whole institution's name) NOTE: If you are a PLUS chapter, add PLUS at the end of school's name
Medical school chapter or LMSA Plus Chapter? *

Allopathic Medical School Osteopathic Medical School LMSA PLUS (undergraduate)
Current President's Name? *
First and Last Name; if Co-Presidents, then add semicolon (e.g. Santos Acosta; Natalie Calderon)
Current President's Email? *
If multiple presidents, please separate with a semicolon (e.g. lmsa1@gmail.com; lmsa2@gmail.com)
Current President's Cell Phone Number? *
(If multiple president numbers please type it like this example: (xxx) xxx-xxxx; (xxx) xxx-xxxx. Please do not forget the semicolon)
Chapter's Email *
Is there an LMSA PLUS chapter currently active/linked to your medical school? *

Yes No
If yes, current PLUS Chapter President's Name and Email *
If no, has your school made an effort to start a PLUS chapter locally? *
If there are no LMSA PLUS chapters affiliated with your medical school, please provide a list of undergraduate institutions in your area (they do not have to be directly affiliated with your medical school) where a chapter could be established *
Which LMSA Region are you in? https://national.lmsa.net/about/regions-chapters/ *

Midwest Northeast Southeast Southwest West
What position(s) does your chapter offer? *

Co-President President Vice-President Secretary Treasurer/Finance Historian/Public Relations Other
Which position(s) have contact with Regional and National LSMA? *

Co-President President Vice-President Secretary Treasurer/Finance Historian/Public Relations Other
When does your chapter transition leadership? *

January February March April May June July August September October November December
How large is your chapter? *

1-10 students 11-20 students 21-30 students 31-40 students 41+ students
How many of your local members are National dues-paying members? *

Less than 10% Between 10-40% Between 40-80% Greater than 80%
Were you aware that your local chapter receives a portion of membership dues from all of your members that pay National dues? *

Yes No Not sure about the difference between Local and National member
Do you have a faculty advisor? *

Yes No
Is your advisor a physician (MD/DO)? *

Yes No
Advisors Name: *
Advisors email address: *
What is your faculty advisor's level of engagement? *

Very Poor (almost never replies to communication, does not attend meetings) Poor (long delays to communication, almost never attends meetings) Moderate (some delays in communication, attends some meetings, occasional help with planning) Good (regularly replies to communications, attends many meetings, contributes to planning) Excellent (timely replies to communications, attends most meetings, offers support and ideas)
How long has your chapter been active in LMSA? *

under 1 year 1 year 2 years 3 years 4 years 5-9 years 10 or more years
Has your chapter had times of inactive status? *

Yes No Not sure
If yes, why?
Examples: Lack of faculty support, low membership numbers, loss of interest, etc.
Select all that apply. What other medical student organizations exist at your institution? *

AMA AMSA ANAMS APAMSA MSPA SNMA SOMA
Does your chapter include other health professions students? *

Yes No
If yes, select all that apply: *

Dental Medicine students Nurse Practitioner students Nursing students Occupational Therapy students Pharmacy students Physical Therapy students Physician Assistant students Speech Therapy students Veterinary Medicine students Other
Does your PLUS chapter have members pursuing allied health professions other than MD/DO? *

Yes No
If yes, select all that apply: *

Dental Medicine Nurse Practitioner Nursing Occupational Therapy Pharmacy Physical Therapy Physician Assistant Speech Therapy Veterinary Medicine Other
How else would you like to be engaged with LMSA on the local, regional, and or/national levels?
Should be Empty:

LMSA National Chapter Directory Form