Ambassador Interest Form

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* 1. Name

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* 2. Email Address

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* 3. Division

Cardiology

Digestive Diseases

Endocrinology

General Medicine and Geriatrics

Infectious Diseases

Rheumatology

Pulmonary

Hospital Medicine

Renal Medicine

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* 4. Rank

Assistant Professor

Associate Professor

Professor

Associate

Senior Associate

Instructor

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* 5. Site

EUH-Clifton

EUH-Midtown

Grady

EUH-St. Joseph's

EUH-Decatur

VA

EUH-Johns Creek

Other/ Multi Site (Please list below)

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* 6. Ambassadors can help you better navigate your new location with tips on parking, building access, etc as well as which faculty development programs are best suited to new faculty. They can also make introductions to other faculty and staff. What area(s) can we most help you with?