^

About ASTRO

Leadership Pipeline Program Application

Personal Info:

Personal Information

ASTROMembership:

How many years have you been an ASTRO member?

Committees/Subcommittees:

Have you ever been and/or are you currently involved in any ASTRO committee(s), subcommittee(s) or task force(s)?

Committee Involvement:

LeadershipPositions:

Relevant Leadership Positions (maximum of five listed):

Honors:

Relevant Honors and Recognitions (maximum of five listed):

Indicate gender:

Gender:

Gender:



Latinx:

Are you of Hispanic, Latino, or Spanish origin?

What is your race? (Check all that apply.):

What is your race?

RaceMultipleChoice:












AbleToAttendAM1:

Are you able to attend the 2021 Annual Meeting in person (October 24-27, 2021)?

AbleToAttendAMYear1:

AbleToAttendAM2:

Are you able to attend the 2022 Annual Meeting (October 23-27, 2022)?

AbleToAttendAMYear2:

CouncilOptions:

What is your preferred Council for your assignment? List all that apply in order of preference. (The options to choose from include the following: Clinical Affairs and Quality, Education, Government Relations, Health Policy and Science.)

Submit Statements:

Please submit the following statements and documents.

StatementInstructions:
  1. Submit a statement of interest that covers all of the points below (250 word limit).

    • Why are you interested in the program?

    • What makes you a strong candidate for this program?

    • What do you hope to gain from this program?

  2. What experience do you have with diversity, inclusion, health equity and/or disparities as it relates to medicine and/or radiation oncology? (250 word limit)

  3. Why did you choose your preferred Council and what type of projects or topics would you like to work on, if any? (250 word limit)

  4. Please submit a CV (limites to six pages) or NIH-formatted biosketch

Upload your statements of interest.:

Upload your statements of interest (compile into one document).

Upload your CV:

Upload your CV.