Aquifer Peer Trainer Application Name* First Last Email* Enter Email Confirm Email Institution* Program Type* MD DO NP PA Current Position/Title* Discipline/Specialty* Why are you interested in becoming an Aquifer Peer Trainer?*How many years of clinical teaching experience do you have, and in what settings? Are you currently teaching?*Describe your coaching experience coaching students (e.g., learner levels, purpose of the coaching). What did you find rewarding? What did you find particularly challenging? How did you work to improve your skills?*Describe your experience delivering faculty development to your peers. What do you enjoy the most? What do you feel are your strengths?*Describe your experience using Aquifer cases and/or assessments with students.*I am able to attend a required orientation session on one of the following days*Choose one June 9, 2022 3:00-5:00 p.m. EST June 16, 2022 3:00-5:00 p.m. EST I am able to attend the monthly virtual meeting*Occurs third Thursday of the month at 3:00 p.m. EST Yes No I am able to do an average of 3-4 hours of work per month*(e.g., reviewing coaching tools, delivering professional development for pilot programs) Yes No Are you an active member of an Aquifer collaborating organization?*Choose any/all that apply AAIM/CDIM AGS AMSER COMSEP PAEA STFM AACOM None Please upload your CV*Acceptable formats: .pdf, .doc, .docxAccepted file types: pdf, doc, docx, Max. file size: 256 MB.PhoneThis field is for validation purposes and should be left unchanged.
