APGO Diversity, Equity & Inclusion Committee Application

Applications deadline is November 30, 2023.
Name*
First Last Suffix
Email*
APGO Member Since*
Job Title*
Insititution*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Have you served on an APGO committee before?*
- Yes
- No
Is yes, in what year?
Please upload documents.*
Accepted file types: pdf, Max. file size: 50 MB.
Applications must include all of the following elements to be considered complete and eligible for review. Combine all documents into one PDF before submitting.
- *Letter of intent (2-page maximum) addressed to Michael Moxley, MD that describes the reason for applying and anticipated contributions as a committee member
- *Current curriculum vitae
- *Letter of support from applicant’s department chair
- *Completed electronic application form