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Journal Club - Faculty Interest Form
Thank you for your interest in serving as faculty for Journal Club.
9
Questions
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1
Name
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This field is required.
First Name
Last Name
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2
Title/Position
*
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3
Affiliated School(s) and/or Organization
*
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Please list the school(s) with which you are a preceptor or faculty member.
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4
Email
*
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example@example.com
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5
Practice Area(s)
*
This field is required.
Select all that apply. If your practice area is not included on this list, please use the "Other" option.
Hospital Pharmacy
Community Pharmacy
Ambulatory Care
Internal Medicine
Family Medicine
Cardiology
Infectious Disease
Oncology
Pediatrics
Critical Care
Other
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6
Area(s) of expertise/interest
Ex. anticoagulation, diabetes, cardiology, pediatrics, etc
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7
Top 3 preferred months for presenting
*
This field is required.
Journal Club is held the second Wednesday of the month from 12:00-1:00pm Central time
January
February
March
April
May
June
July
August
September
October
November
December
No preference
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8
Proposed topic/journal article
Please share a topic idea and/or article published within the past year to be used for your presentation. You won't be stuck with this - we would just like to have an idea of what you are interested in covering.
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9
*
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Please upload a recent version of your CV.
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10
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