FSDPA Foundations in Dermatology Application

FSDPA Foundations in Dermatology Application

The Florida Society of Dermatology PAs is excited to invite you to apply for the inaugural FSDPA Foundations in Dermatology Program, which will take place at FSDPA’s 2025 New Wave Dermatology Conference at the JW Marriott Turnberry in Aventura, FL. The FSDPA Foundations in Dermatology Program will take place on Wednesday May 14th, 2025 before the start of the New Wave Conference, and conclude on Saturday May 17th, 2025 with the close of the conference. This program offers an exclusive opportunity for newer providers who want to advance their dermatology expertise. This program is designed to support PAs and NPs who practice in dermatology and are eager to expand their knowledge and leadership within the field. The ideal candidate has less than 5 years of full time medical dermatology experience.
Qualifications:
Must be an early career PA or NP with 0-5 years of experience in medical dermatology

(Students are not eligible to apply)

Must currently practice in the field of medical dermatology full-time

Applicant's collaborating physician must be a board certified dermatologist

Must be available to attend the entirety of the FSDPA Foundations in Dermatology Program & New Wave Dermatology Conference

May 14th - 17th, 2025 in Aventura, FL
Personal Information:

How can we reach you?
Full Name*

First NameLast Name
Credentials*
Phone Number*
E-mail*
example@example.com
Dermatology Practice Information:

List information for your full-time dermatology practice.
Practice Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Office Contact*
Collaborating Physician Information:

Applicant's collaborating physician must be a board certified dermatologist.
Collaborating Physician's Name*
Collaborating Physician's NPI*
Don't know your Collaborating Physician's NPI? Look it up HERE.
Licensing Information:
NPI Number*
State License #*
Dermatology Career Information

FSDPA Foundations in Dermatology is open to PAs & NPs with 0-5 years of practice. Must be actively practicing medical dermatology full-time.
How many years have you been practicing dermatology?*
What percentage (%) of your practice is medical dermatology?*
What percentage (%) of your practice is surgical dermatology?*
What percentage (%) of your practice is cosmetic dermatology?*
Short Answer Questions:

Please answer in 500 words or less. Please note: All answers will be screened for any form of AI use. Applicants found to use any form of AI (i.e. ChatGPT, etc...) will be declined.
Where do you see yourself in five years within the dermatology field, and how will the FSDPA Foundations in Dermatology Program help you achieve your goals?*
What role do you think mentorship plays in dermatology, and have you had a mentor who impacted your career? If chosen for the FSDPA Foundations in Dermatology Program you will be paired with a mentor. How do you feel this would help develop your career?*
What is the biggest challenge currently facing dermatology providers, and how do you think PAs & NPs can play a role in addressing it?*
Do you see yourself seeking out leadership roles within the field of dermatology? If so in what capacity do you see yourself contributing?*
Please provide any other relevant details you would like the selection committee to consider.
Submission Attestation:
By submitting this application, I certify that all information provided is accurate to the best of my knowledge.
Full Name - Typed Signature
Typing your name above will act as your official signature for this application.
Date*

MonthDayYear
Date
Applications for the FSDPA Foundations in Dermatology Program are accepted on a rolling admissions basis.

You will be notified via the email provided in your application, and must respond to your acceptance within 1 week of receiving the email to confirm your place in the program.
Should be Empty:

FSDPA Foundations in Dermatology Application

Qualifications:

Personal Information:

Dermatology Practice Information:

Collaborating Physician Information:

Licensing Information:

Dermatology Career Information

Short Answer Questions:

Submission Attestation: