NAEMSP/Stryker EMS Medicine Early Career Medical Director Award Application

Instructions: Please answer the following questions using 300 words or less for each.

Introspection: How will this award help you accomplish your EMS career ambitions? *

Word Limit: 300

Introspection: Recognizing that all candidates are highly qualified, what experience or qualifications set you apart from the other candidates? *

Word Limit: 300

Introspection: What will be your greatest impact on EMS? *

Word Limit: 300

Introspection: What personal attributes will make you an effective EMS Physician and national EMS leader? *

Word Limit: 300

Vision: What is (are) the greatest challenge(s) facing EMS in the next 5-10 years? *

Word Limit: 300

Vision: Where do you see yourself in EMS 5-10 years from now and how do you plan to achieve this station? *

Word Limit: 300

Open Forum: Anything else you would like to share with the Selection Committee? *

Word Limit: 300

Name *

First

Last

Email *

I attest that: *

I am a Diplomate in good standing of an American Board of Medical Specialties (ABMS) Member Board or Bureau of Osteopathic Specialists (BOS).
I comply with the ABEM or AOA Policy on Medical Licensure. Licenses must be valid, full, unrestricted and unqualified including educational or temporary licenses.
I am a member in good standing of NAEMSP®.

Date / Time *

Upload a PDF of your CV

Click or drag a file to this area to upload.

Your Curriculum Vitae is required for submission.

Upload supporting documentation here - 3 letters are required with your submission *

Click or drag files to this area to upload. You can upload up to 3 files.

Three letters are required as part of the completed application:‎ a. One letter of support from the applicant's mentor, speaking to ‎impact and feasibility.‎ b. Two additional letters of support from both the Academic ‎Institution/Healthcare System and the EMS agency the applicant will be ‎affiliated with during the award period.‎

Upload Workplan outlining clearly the goals ad objectives, as well as a proposed timeline for completion. *

Click or drag files to this area to upload. You can upload up to 5 files.