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Accepting Applications for the 2013 ARTE in Dermatology Scholarship Program!

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    2013 ARTE SCHOLARSHIP

APPLICATION


 
First Name
Middle Name
Last Name
Degree
Residency Program
Gender
M
F
Roommate Request
Work Address
Work City
Work State
Work Zip
Work Country
Work Phone
Work Email
Home Address
Home City
Home State
Home Zip
Home Country
Personal Phone
Personal Email
I prefer to be contacted using (indicate one phone number and one email):

Preferred Phone
  

Preferred Email
   
As of July 1, 2012 I will be a (please check):

Dermatology Resident 1st Yr


Dermatology Resident 2nd Yr


Dermatology Resident 3rd Yr


Dermatology Fellow


I am also a chief resident in
 
I will be a chief resident in
 
I have read and agree to The ARTE Scholar Commitment as outlined on page 2 of the ARTE Program Information sheet. I understand that I will be held accountable to this commitment and that receipt of the ARTE Scholarship package is dependent upon fulfillment of this commitment.
I have attended ODAC before as an ARTE Scholar in year(s):
 


My hospital or university program has implemented new rules and regulations that may affect this scholarship award. Please contact me to discuss my interest in this scholarship.
Become fans of the “ARTE Scholars” page on Facebook so that we can provide you with further program updates! Please check the box to the left if you currently have a Facebook Page.
Please attached your CV/Resume   


For questions, please email at Kathy.Lopes@sanovaworks.com or call 646-736-4337.