North Carolina College of Emergency Physicians

The North Carolina College of Emergency Physicians is pleased to offer a grant to eligible resident(s) to attend the ACEP Leadership and Advocacy Conference in Washington, DC. Final grant determinations are made by the NCCEP Board of Directors.

Please complete the application below, including a letter of support from your Program Director, to be considered.

Resident Grant Application

Name(Required)

First Last

Credentials (MD/DO)(Required)

Name of Residency Program(Required)

ACEP/NCCEP Member(Required)

Yes

Please list your areas of legislative interest.(Required)

Please share any prior advocacy you have done or any legislative relationships you may have.(Required)

What do you hope to learn at/take back from attending LAC?(Required)

How did you learn about the NCCEP grant?

Please upload a letter of support from your Program Director.(Required)

Max. file size: 50 MB.