Request for Clinical Skills Workshop Support

ACR is proud to support radiology interest groups within medical schools that serve to connect students who are interested in radiology.

Please review the Tier level requirements and explore the resources and tools we can provide to educate and support students in your group here: https://www.acr.org/Membership/Member-Sections/medical-students/for-students/radiology-interest-groups.

Application review and determination takes approximately two to three weeks. If you have questions during this period, please contact Joan Lynch at jlynch@acr.org.

Name

Phone Number

Position

Institution

Faculty Sponsor Name (If not provided above)

Terms & Conditions

• ACR appreciates receiving applications to the Program. It reserves the right to accept applications from some, but not all, medical school or affiliated programs that apply. • The materials that ACR provides to Program participants are informational resources only. ACR is not liable for any act or omission by a medical school or affiliated program related to using the materials. • Additional terms and conditions are defined in the specific tier information. On behalf of my medical school program, I understand and agree to the terms and conditions listed on the application as a condition of participation in this American College of Radiology Tiered Workshop Program.

Checking the box indicates acknowledgement and acceptance of the above terms.

Tier URL will be added here

Which Tier Level are you interested in?

Tier 1 - One medical school hosting a one-day event with 10-40 students anticipated to attend.

Tier 2 - Two to three medical schools partnering for a one-day event with 40-75 students anticipated to attend.

Tier 3 - Four or more medical schools partnering for a one-day event with 75-150 students anticipated to attend

Program or Institution URL

Program or Institution Mission / Vision

Please provide three possible dates for your workshop.

If you selected Tier 2 or 3, please indicate the other institutions that you are partnering with.

Partner institutions are those who are actively participating in the development and execution of the workshop. This is not a list of institutions who will be invited to attend the event.

How many students are you expecting?

Contact if not listed above

Do you have a Radiology Interest Group at your institution?

If you answered no, above, do you plan on developing one in the future?

Brief description of why you want to host a Radiology Workshop.

Please explain why ACR would be a good partner for your workshop.

Has ACR sponsored/funded your organization in the past? If so, please list the date(s) & program name?

This will not preclude you from receiving support. Support will be provided once an academic year (July-June).

How would you promote this partnership?

Send me a copy of my responses

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