Medical Student Section: Board, Council, Committee Application

Medical Student Section: Board, Council, Committee Application  

Section 1: Demographic Information
Name:
Mailing Address:
City:
Zip:
Phone:
E-mail:
Program Classification (MS1, MS2, etc.):

   

Section 2: Board, Council and Committee Information

If you would like a short description of the board/council/committee positions, please click here.

Board/Council/Committee History:

I currently serve as a MSS representative/alternate representative and wish to remain on the same board/council/committee I currently serve as a MSS representative/alternate representative and wish to serve on a new board/council/committee I have never served on a board/council/committee and wish to do so now

Choice 1:   TMA Foundation Board (1) TEXPAC Executive Committee TEXPAC Candidate Evaluation Committee TEXPAC Board of Directors Council on Constitution & Bylaws Council on Health Promotion Council on Health Service Organizations Council on Legislation Council on Medical Education Council on Practice Management Services Council on Public Health Council on Scientific Affairs Council on Socioeconomics Committee on Blood & Tissue Usage Committee on Cancer Committee on Child & Adolescent Health Committee on Continuing Education Educational Scholarship & Loan Committee Committee on EMS & Trauma Committee on Infectious Diseases Committee on Maternal & Perinatal Health Committee on Membership (1) Patient-Physician Advocacy Committee Committee on Physician Distribution & Health Care Access Committee on Physician Health & Rehabilitation Committee on Professional Liability Committee on Rural Health Border Health Caucus

Choice 2:   TMA Foundation Board (1) TEXPAC Executive Committee TEXPAC Candidate Evaluation Committee TEXPAC Board of Directors Council on Constitution & Bylaws Council on Health Promotion Council on Health Service Organizations Council on Legislation Council on Medical Education Council on Practice Management Services Council on Public Health Council on Scientific Affairs Council on Socioeconomics Committee on Blood & Tissue Usage Committee on Cancer Committee on Child & Adolescent Health Committee on Continuing Education Educational Scholarship & Loan Committee Committee on EMS & Trauma Committee on Infectious Diseases Committee on Maternal & Perinatal Health Committee on Membership (1) Patient-Physician Advocacy Committee Committee on Physician Distribution & Health Care Access Committee on Physician Health & Rehabilitation Committee on Professional Liability Committee on Rural Health Border Health Caucus

Choice 3:   TMA Foundation Board (1) TEXPAC Executive Committee TEXPAC Candidate Evaluation Committee TEXPAC Board of Directors Council on Constitution & Bylaws Council on Health Promotion Council on Health Service Organizations Council on Legislation Council on Medical Education Council on Practice Management Services Council on Public Health Council on Scientific Affairs Council on Socioeconomics Committee on Blood & Tissue Usage Committee on Cancer Committee on Child & Adolescent Health Committee on Continuing Education Educational Scholarship & Loan Committee Committee on EMS & Trauma Committee on Infectious Diseases Committee on Maternal & Perinatal Health Committee on Membership (1) Patient-Physician Advocacy Committee Committee on Physician Distribution & Health Care Access Committee on Physician Health & Rehabilitation Committee on Professional Liability Committee on Rural Health Border Health Caucus

Would you be willing to serve on more than one board, council or committee?

Yes No

If it is not possible to assign you to one of your three choices, would you be willing to serve on another board, council or committeee?

Yes No

 Explain why you are interested in serving on a TMA board, council or committee:

Pertinent background information:

Activities, honors, offices held in medical school: