2024 Annual Symposium Student Volunteer Program | AMIA - American Medical Informatics Association

First Name

Last Name

What Training Program or Fellowship Program are you enrolled in?

Please provide a URL or website that provides information concerning your training program.

Are you a current AMIA Student Member? (You must be a current AMIA member in order to qualify for participation in this program)

Yes

Have you ever been an AMIA student volunteer before?

Yes

Are you a presenter at this conference?

Yes

Is your academic informatics program supporting your travel and lodging?

Fully

Partially

Not at all

Do you have other funding to support travel and lodging?

Yes

Not sure

Why do you want to volunteer?

Please describe why you want to be a student volunteer and how being selected would help you attend the conference and assist you with your career development.

(3-5 sentences)

Demographic Information

Gender (choose one)

Ethnicity (choose one)

No, not of Hispanic, Latinx, or Spanish origin

Yes, I am of Hispanic, Latinx or Spanish origin

Prefer not to answer

Race (choose one)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other

Multiracial/Multiple Races

Prefer not to answer

Please Read and Acknowledge

I understand that to participate in the AMIA Student Volunteer Program I will be responsible for monitoring the number of session slots listed on the AMIA Student Volunteer page.

I understand that in making the selections for the sessions I will monitor, it is not guaranteed that I will get my top choices.

I have read and agree to the requirements stated above.

Yes

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