Educational Program Application Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Password must contain the following: 12 Characters 1 Uppercase letter 1 Lowercase letter 1 Number 1 Special character First Name Last Name Institution Email Program Title Do you have a co-presenter?YesNo Co-Presenter Information First Name Last Name Institution Email Role (co-presenter, panelist, co-author, etc...) What type of presentation is this? Podcast (Audio Only)Webinar (Audio and Visual)Other Other - Please specify Do you need support from PeDRA to record this program, or is it pre-recorded and ready to be reviewed by PeDRA staff?I would like PeDRA's help recording this program.My program is recorded and ready for review. Is this program based on work related to a PeDRA Study or PeDRA-Funded grant or fellowship?YesNoNot sure When will you be ready to record your program?I'm ready now2 - 4 weeksMore than 4 weeks Anticipated run time of the program:Less than 30 minutes30-45 minutesMore than 45 minutesUnsure Who is the intended audience for this program?Trainees (including medical students, residents, and clinical fellows)Early Investigators (less than 7 years out of training)All career levelsUnsureOther Other - Please specify Please describe your program and how it relates to PeDRA mission to create, inspire, and sustain research to prevent, treat and cure childhood skin disease. (350 words max) Tell us what your project is trying to accomplish and where it stands now. If this is a new study idea please provide relevant background to help the PeDRA Biostatistician prepare for your consultation. If you have already worked with a biostatistician on your project please include that here. x Please use this space to provide any additional information related to your presentation request (OPTIONAL): Tell us what your project is trying to accomplish and where it stands now. If this is a new study idea please provide relevant background to help the PeDRA Biostatistician prepare for your consultation. If you have already worked with a biostatistician on your project please include that here. x If you have any supporting documents you would like to include, please upload them here. Use this space to upload any files (e.g. grant applications, posters, manuscripts) that might help us evaluate this request and/or prepare the PeDRA's Associate Director of Educational Programs. By clicking "I agree", the Applicant agrees that they are permitted to present this material. I AGREE Save my progress and resume later | Resume a previously saved form Contact Information
