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Educational Programs Submittal Form

SUBMITTER CONTACT INFORMATION

First Name
Last Name
Email Address
Phone Number
SSCI Member	YESNO
If Yes, Which?	NONEFELLOWMEMBER

PROGRAM INFORMATION

Program Name
Number of Residents

INTERNAL MEDICINE SPECIALTY AREAS

Area 1
Area 2
Area 3

PROGRAM CONTACT

Contact Name
Email Addres:
Telephone

PROGRAM FOR THESE DAYS & TIMES

Sundays	YESNO		Timing
Mondays	YESNO		Timing
Tuesdays	YESNO		Timing
Wednesdays	YESNO		Timing
Thursdays	YESNO		Timing
Fridays	YESNO		Timing
Saturdays	YESNO		Timing

Related Information

• Educational Exchange Program (EEP)
• SRM 2023 Career Advancement Workshops
• SRM 2019 Career Advancement Workshops
• SRM 2018 Career Advancement Workshops

The SSCI Thanks Its Sponsors

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