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Name (first and last)

Email Address (Yale preferably)

Program

Traditional Internal Medicine
Primary Care Internal Medicine
Internal Medicine/Pediatrics

What Distinction Pathway are you applying to?

Clinical Educator
Global Health and Equity
Investigation
Quality Improvement and Physician Leadership

What are your career goals? How would participation in the Distinction selected above help you achieve these goals? (500 words or fewer)

If you have particular scholarship interests or project ideas related to the Distinction selected above, please briefly describe them. (500 words or fewer)