MSS BoT Nomination Form

Applicant information

Of the information collected in this section of the application, only your name, credentials, and pronouns (if any selected) will be made available online for review by members of your Section and other AMA Members.
Name*

First NameMiddle NameLast Name
Credentials
What are your pronouns? Select all that apply.

He/HimShe/HerThey/ThemRather not sayOther
Physical mailing address*

Street Address

Street Address Line 2

CityState

Zip Code
Date of birth*

MonthDayYear
Email*
example@example.com
Primary phone number*

Area CodePhone Number

AMA-MSS application
Name of Medical School*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Expected date of graduation*

MonthDayYear
Date
Review the AMA-MSS Internal Operating Procedures.
I have read and agree to abide by all campaign rules as outlined in the MSS Internal Operating Procedures.*

Yes
Upload Dean's letter of endorsement*

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If not downloaded before, you can access the Dean's letter of endorsement here.

Endorsements, letters of support, and curriculum vitae

These files will be published online as part of your application for review by AMA Members. Please remove any personal contact information or private details you do not wish to be shared.
List endorsing organizations (optional)
Applicants have the option, but are not required, to upload up to two letters of support from endorsing organizations. Upload letters of support from endorsing organizations (optional).

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Upload curriculum vitae *

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3 pages max. If submitting a longer CV, only the first 3 pages will be published. Cancelof

Please continue
Are you an AMA member?*

YesNo
Are you a member of the AMA House of Delegates?*

YesNo
Do you agree to serve in the position for which you are applying?*

YesNo
Please provide a statement of interest that describes what you are looking to accomplish in this position and highlights current/previous leadership experiences that are relevant to this position (250 words max)*

up to 250 words0/250
Professional headshot (optional)

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.JPEG or .PNG only Cancelof

Click "submit" below to finalize and transmit your application. You will receive an email confirmation with a copy of your application and all submitted documents or files.

Please direct any questions to AMASections@ama-assn.org.
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Applicant information