2026 AIM Program Application

2026 AIM Application Form

For those who are selected, roundtrip, economy airfare; 3 nights lodging; and meals for the duration of the program will be provided.
Contact Information
Name*

PrefixFirst NameLast NameDesignation (MD, PhD, DO, RN. etc.)
Institution/Company*
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
State of Licensure*
License Number*
NPI Number*
Specialty*
Are you currently a Fellow?*

YesNo
Program-Related Information
CV*

Cancelof
Letter of Recommendation*

Cancelof
What has driven your interest in clinical immunology? *

0/200
What aspects of the AIM program description do you think will be most helpful to you at this stage in your career? *

0/200
Submit an idea for a clinical trial to be pitched in our IMmunoVate shark-tank like experience. *
I understand that if selected to attend the 2026 AIM program, I will be required to attend the program for its entire duration, Friday to Sunday morning.*

I understand
Should be Empty:

2026 AIM Application Form