MedLink Scholars Guest Speaker, Event Proposal, & Social Media Post Submission Form Contact & Institutional Information Name * First Name Last Name Email * Phone * (###) ### #### Institution/Program * Role/Level of Training * Pre-Medical Student Medical Student (MS1-MS4) Resident Fellow Faculty Other Are you submitting this proposal as an individual or on behalf of a chapter/group? * Individual Chapter/Group Representative Proposal Overview What are you requesting support for? Guest Speaker Educational Event Social Media Promotion Flyer or Digital Asset Only Other Specialty Focus (select one): * Dermatology Internal Medicine Surgery Pediatrics OB/GYN Psychiatry Emergency Medicine Family Medicine Radiology Neurology Pathology Anesthesiology PM&R Subspecialty / Other Proposed Speaker Name (if applicable): Affiliation and Title of Proposed Speaker: Would you like MedLink Scholars to assist with speaker outreach? Yes No Possibly – pending availability Event Details Proposed Title of Event or Campaign: Proposed Date (or preferred date range): MM DD YYYY Proposed Date (or preferred date range): Proposed Time (include time zone): Estimated Duration: 30 minutes 1 hour 90 minutes Other Event Format Virtual (Zoom, IG Live, etc.) In-person Hybrid Platform (Zoom link, IG handle, etc. if already arranged): Will this event be recorded or live only? Live only Recorded for future use Undecided Do you anticipate needing RSVP forms, registration links, or email blasts? Yes No Not sure yet Promotional Material Needs What promotional assets are needed? Instagram Post Instagram Story Flyer (square) Flyer (vertical for print or story) Email graphic None Will your team design the flyer or do you need design assistance? We will design and submit We need MedLink’s design team to create it Partial – we have a draft but need edits Deadline by which flyer or post is needed (must be at least 10 days before event): MM DD YYYY Description and Key Messaging Brief Description of Event or Post (for flyers, emails, and social posts): Key topics to be covered, hashtags, or messages you want included in promotion: Target audience for this event/post (check all that apply): Pre-Med Students Medical students Residents Faculty Public/Community Audience Other Logistics & Review Are you requesting support with live event management (e.g., moderator, tech support, co-hosting)? Yes No Possibly – unsure at this time Have you checked the MedLink calendar for scheduling conflicts? Yes No, please help me confirm availability I am flexible with the event date Anything else the MedLink Scholars team should know? Terms & Conditions Please review and agree to the terms and conditions below. By clicking, you confirm your acceptance. * I confirm that I have reviewed the information provided and understand that final event approval is subject to MedLink Scholars leadership review. If applicable, I agree to notify MedLink immediately if the proposed speaker cancels, the date changes, or promotional needs are updated. I understand that promotional requests submitted fewer than 14 days before the event may not be guaranteed. Thank you!