2023 MD/PhD Attendee Survey

Please submit this form AFTER registering. This form is required to attend the conference for all attendees. This is required for NIH reporting purposes.

Please try not to submit this form more than once (e.g., check in your email confirmations if you have already submitted this form if you are not certain). If you submit this form without an abstract, and then later want to submit an abstract, you will have to fill out this form a second time. If you do submit this form more than once, please email us at mdphdnationalconference@cuanschutz.edu so we can be made aware to merge your duplicate forms correctly.

Abstract submissions are due BEFORE May 20th for an oral presentation, to be considered for a Diversity Travel Award, or before June 1st for a poster only.

If you have any questions, please email us at mdphdnationalconference@cuanschutz.edu.

Thank you!

First Name (formatted the same as at registration)

Last Name (formatted the same as at registration)

Email Address (same school email that you registered with)

University/College Program Name (formatted the same as at registration)

Which of the following best describes you?

Do you have a disability or disadvantaged background as identified by the NIH?

See more information here: https://extramural-diversity.nih.gov/diversity-matters

Will you be submitting an abstract?

Abstract submission is not required to attend the conference, but is required for consideration in either the oral or poster presentation sessions. Please attach your abstract to this form (file upload at the bottom). You must submit an abstract to be considered for an oral presentation, poster, or Diversity Travel Award.

Must be submitted before May 20th to be considered for an oral presentation or Diversity Travel Award. Before June 1st to be considered for a poster.

2000 total character limit (including spaces)

Would you like to be considered for an oral presentation only, a poster only, or be considered for both?

Selecting "both" means your abstract will first be considered for an oral presentation, and if it is not selected, then it will be considered for a poster. No student will present an oral presentation AND a poster (it is either/or).

The priority of oral presentation selection is not influenced by the choice between oral presentation only or both.

If you are submitting an abstract, what is the title?

Please limit length to one that could easily fit on a poster or powerpoint slide.

Please select any categories that you feel your abstract could fall under.

Final presentation categories will be selected later based on the submitted abstracts. If your abstract is selected for an oral presentation, the committee will do its best to match it to a category based on your selections here.

Would you like to be considered for a Diversity Travel Award?

Submission of an abstract (see above) is required to be considered. Attendees may also submit a separate DTA document (2000 total character limit including spaces; file upload at the bottom) explaining why they qualify for a diversity award and/or how it would help them. Award recipients are mainly chosen based on the quality of the submitted abstract. The optional submitted DTA document will be de-identified before committee review to respect privacy.

14 Diversity Travel Awards in the amount of $1000 each are being offered. The intent of these travel awards is to increase the attendance of students with diverse backgrounds at the National MD-PhD Student Conference.

Please see more information on the Diversity Travel Award Guidelines at the Conference Website: https://medschool.cuanschutz.edu/mstp/md-phd-conference

Are you willing to be emailed by sponsors regarding products, services, opportunities, and/or other information?

File Upload(s)

If you submit an abstract and/or a diversity travel award narrative, please attach each file here (as separate word document files; please do not submit PDFs). To help us with de-identifying the documents before review, while being able to easily rematch the findings after review, please do the following:

(1) Please try not to put your name or your current school's name within the attached documents.

(2) Please name your attached files in the following way:

Abstract: LastnameFirstname_Abstract

Diversity Travel Award: LastnameFirstname_DTA

Thank you!

Drop your files here

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