MITE Academy Scholars Program Application

For additional instructions about the application, see the FAQ tab.

Questions? Please contact Kathleen Fairfield, MD, MPH, DrPH.

If you have any technical questions, please contact Melinda Hull, Ed.D. in the Department of Medical Education.

  • Applicant Information

  • Professional Information

  • Mentor Information

  • Enter the name of your mentor
  • Experience and Goals

  • Describe your past and current teaching experience.
  • What do you hope to gain from the Academy Scholars Program?
  • What specific healthcare professions education topics or areas are of interest to you? Mark all that apply.
  • What are your specific career goals? Where would you like to be in your career in five years? Are you also applying to the Academic Pathway?
  • Documents

  • Your attached description should be no more than 1000 words, approximately 2-3 pages.
    Drop files here or
    Accepted file types: pdf, docx, doc, Max. file size: 128 MB.
    • Please attach your CV and your project mentor's CV.
      Drop files here or
      Accepted file types: pdf, docx, doc, Max. file size: 128 MB.
      • Drop files here or
        Accepted file types: pdf, docx, doc, Max. file size: 128 MB.

          Include letters of recommendation from your project mentor and supervisor (e.g., director, Department Chief). The letter from your supervisor must include the following statement:

          "In support of this application, I agree that [your name] will be given sufficient release time from duties (0.05 FTE) to attend all Scholar seminars. Schedules will be adjusted accordingly."

          The letter of recommendation from your project mentor should include a description of the mentor's role in your project.

          One additional letter of recommendation may optionally be submitted.

        • This field is for validation purposes and should be left unchanged.