Residency Showcase Participant Info Form

Thank you for participating in the 2020 Tennessee Residency Showcase!

This form and requested documents must be submitted no later than WEDNESDAY, SEPTEMBER 16, to ensure that the information you wish to share is available online in advance of the Showcase.

Please select your participant category below to get started!

If you have any questions, please contact Lindsey Inman at lindsey@localhost or 615-256-3023.

* = Required Field

PARTICIPANT CATEGORY:*

Please select your category:

Prospective Residency Candidate
Residency Program

NAME*

Enter your name as it should appear in Residency Showcase materials.

First Middle Last

CONTACT INFORMATION:*

The contact information you provide below will be made available to residency programs for review but will not be available to other prospective residency candidates. Do you wish your contact information to be shared directly with prospective residency programs?

Yes
No

EMAIL ADDRESS:*

PHONE:*

MAILING ADDRESS:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

SCHOOL OR COLLEGE OF PHARMACY:*

Belmont University College of Pharmacy
Bill Gatton College of Pharmacy at ETSU
Lipscomb University College of Pharmacy and Health Sciences
South College School of Pharmacy
Union University College of Pharmacy
University of Tennessee Health Science Center College of Pharmacy

GRADUATION YEAR:*

PROGRAM(S) OF INTEREST:*

Check all that apply.

PGY1 Residency
PGY2 Residency
Fellowship

FILE UPLOADS:

Please upload your Curriculum Vitae or Resume, as well as any other documents you would like to share with participating Residency Programs. This information will be made available to Residency Programs for review prior to the Showcase.

The maximum size for each document is 256MB. If you have difficulty uploading files, please email them to alec@localhost.

Drop files here or

Max. file size: 256 MB.

FILES:
Your Curriculum Vitae or Resume, as well as any other documents you would like to share with participating Residency Programs, should be emaled to alec@localhost by September 16. This information will be made available to Residency Programs for review prior to the Showcase.

INSTITUTION NAME:*

Enter the name of your institution as it should appear in Residency Showcase materials.

INSTITUTION WEBSITE:*

INSTITUTION MAILING ADDRESS:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

PROGRAM DIRECTOR:*

First Middle Last

PROGRAM DIRECTOR'S EMAIL ADDRESS:*

PROGRAM DIRECTOR'S PHONE:*

PROGRAM(S) AND PRESENTER(S)*

List each residency/fellowship program that will be presented during the Residency Showcase, along with the name of the person who will present it, as it should appear in Showcase materials. Please include the presenter's email address and phone number. To add additional programs, click + at the end of the row. Click – at the end of a row to delete it. (These symbols may appear underneath the entry when viewed on a small screen.)

Program	Presenter	Presenter Email	Presenter Phone

FILES:
Any documents you would like to share with participating Prospective Residency Candidates should be emailed to alec@localhost by September 16. Documents should include information about your program(s), such as specifics about required and elective rotations, project opportunities, day-to-day tasks, benefits, and post-residency information. This information will be made available to Prospective Residency Candidates for review prior to the Showcase.

FILE UPLOADS:

Please provide any documents you would like to share with participating Prospective Residency Candidates. Documents should include information about your program(s), such as specifics about required and elective rotations, project opportunities, day-to-day tasks, benefits, and post-residency information. This information will be made available to Prospective Residency Candidates for review prior to the Showcase.

The maximum size for each document is 256MB. If you have difficulty uploading files, please email them to alec@localhost.

Drop files here or

Max. file size: 256 MB.

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