Orthopaedic Surgery Faculty Development Request 
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Email *
What is your name? *
 Application Type
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Required
What is the activity?
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Required
If this is a Course for Specific Skills & Knowledge - please name the course and how it applies to your learning/development.  Each submission will be considered on a case by case basis.
If you selected "New-please describe"
Write here, please.
What is the time (duration / dates)?
*
What is the direct cost of the activity? Please breakdown (e.g. travel, lodging, food, tuition - please estimate as needed) and include total cost. *
What is the rationale (how does it benefit you, the section, and the department)? *
Please list 3-5 objectives that a participant should (or you plan to) achieve by completing this program.
*
Propose a potential action plan back at Michigan Orthopaedics as a result of participation in this program.
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