Winston Faculty Symposium Application

1. Please fill out the form below and we will be in touch shortly.

First Name *This question is required.

Last Name *This question is required.

Suffix/Degrees *This question is required.

Title *This question is required.

University *This question is required.

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip Code *This question is required.

Email Address *This question is required.

Phone Number *This question is required.

2. Please describe below your background and current role as it relates to teaching health policy in your academic setting: *This question is required.

3. Please describe below what you would hope to gain from the Winston Faculty Symposium experience: *This question is required.

4. What topics might you be particularly interested in exploring as a Winston Faculty Symposium attendee? *This question is required.

5. Please upload a copy of your most recent CV *This question is required.

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Winston Faculty Symposium Application

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