MITE Academy Scholars Program Application

Questions? Please contact Kathleen Fairfield, MD, MPH, DrPH or Bob Bing-You, MD MEd.

If you have any technical questions, please contact Elizabeth (Sue) Rose EdD, MPH in the Department of Medical Education.

  • Applicant Information

  • Professional Information

  • Mentor Information

  • Enter the name of your mentor

  • Experience and Goals

  • Describe your past and current teaching experience.
  • What do you hope to gain from the Academy Scholars Program?
  • What specific healthcare professions education topics or areas are of interest to you? Mark all that apply.
  • What are your specific career goals? Where would you like to be in your career in five years?

  • Documents

  • Your attached description should be no more than 1000 words, approximately 2-3 pages.
    Drop files here or
    Accepted file types: pdf, docx, doc, Max. file size: 128 MB.
    • Please attach your CV and your project mentor's CV.
      Drop files here or
      Accepted file types: pdf, docx, doc, Max. file size: 128 MB.
      • Drop files here or
        Accepted file types: pdf, docx, doc, Max. file size: 128 MB.

          Include letters of recommendation from your project mentor and supervisor (e.g., director, Department Chief). The letter from your supervisor must include the following statement:

          "In support of this application, I agree that [your name] will be given sufficient release time from duties (0.05 FTE) to attend all Scholar seminars. Schedules will be adjusted accordingly."

          The letter of recommendation from your project mentor should include a description of the mentor's role in your project.

          One additional letter of recommendation may optionally be submitted.

        • This field is for validation purposes and should be left unchanged.
        Save and Continue Later