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2016 Stanford Medicine X Student Leadership Application

Home / 2016 Stanford Medicine X Student Leadership Application

2016 Stanford Medicine X Student Leadership Application

We are so excited that you are interested in applying for the Student Leadership program to attend Stanford Medicine X on September 16-18, 2016! If you haven't yet done so, please take a moment to review information about the scholarship program.

The application period opens April 15, 2016. Due to unprecedented demand, we're extending the deadline until Sunday, May 22nd, 2016 at 5 PM PST.

Please note that this page may time-out (refresh) after a period of inactivity, causing you to lose any unsaved content. We recommend you type your application into a word processor and then cut and paste the text into the online form for submission.

If you have any questions, need assistance or require this form in another format, please email us at stanfordmedx@gmail.com.
1 Scholarship Application
2 Financial Application
  • Applicant Information

  • Please state your current school and degree program (MD, PhD, RN, etc...) Please note, applicants must be enrolled as a full-time student at an accredited degree-granting academic institution.
  • Photo

    Why do we need this? If you win a scholarship, we would like to recognize your accomplishment on our Medicine X website. By uploading your photo, you agree to give us permission to use it on our website. We will also need your photo to create an ID badge for the conference.
  • Please upload a digital photo of your face for use by Medicine X on our website and on your ID badge in the event that you are awarded a scholarship. (JPEG, PNG, GIF are all acceptable formats).
  • Conference Attendance

  • We expect students in the Student Leadership program to attend all days of the conference, September 16-18, 2016.
  • Scholarship Track Preferences

  • *Please refer to the Medicine X Student Leadership program page for more information about the different tracks.
    Please answer the subsequent questions that correspond to the track you're interested in. You may apply to both the Engagement & Producer and Presenter track, however, conference participation is limited to one track per student.
  • Engagement & Producer Track Questions

    Description: The purpose of the Engagement & Producer Track is to provide an opportunity for students to attend Stanford Medicine X and interact—both in-person and through social media—with conference attendees and the world-at-large. Students accepted to the Medicine X engagement/producer track will be paired with ePatient scholars from the ePatient engagement/producer tracks and will participate in a collaborative design challenge.

    Selection Criteria: Successful applicants will demonstrate a history of student community engagement, outreach and advocacy, with preference for individuals using emerging technologies such as blogs, Twitter, and social media to pursue these goals.

  • Presenter Track Questions

    Description: The purpose of the presenter track is to provide an opportunity for students to attend and speak at the Stanford Medicine X. By providing a student voice to the proceedings, participants will help share and disseminate the knowledge to educate and inspire others.

    Selection Criteria: Applicants will be asked to submit a speaking proposal that describes their story and what they would like to speak about. Student talks in the presenter track will be five minutes in length and follow a pecha kucha/Ignite! format.

  • Examples of previous topics include:
    • • How do you consider yourself an engaged health care provider?
    • • How do you see yourself working together in partnership with patients?
    • • How does technology enable you to care for your patients?
  • General Applicant Questions

  • Diversity       Health       Innovation       Empathy       Learning       Education
    Patient       Respect       Future       Design       Technology       Challenge
    Community       Inclusivity       Engagement       Leadership       Stakeholders

  • For example, classroom vs. real practice, silos in health care, lack of interdisciplinary education, underuse or overuse of technology.



  • Consent to Contact

  • Financial Application

    Financial scholarships are intended to support students with the greatest financial need. Note that partial scholarships to Medicine X will be awarded on a financial needs basis.

    Separate financial assistance may be available for travel expenses and lodging costs.

  • Financial Need Assessment

    The following questions are such that the Medicine X Student Leadership Program Advisory Panel may ascertain which student applicants demonstrate financial need.
  • Certification of Application

  • PLEASE ENTER YOUR INITIALS ABOVE TO CERTIFY THIS FORM.

    The Medicine X Student Leadership Advisory Panel recognizes that situations may suddenly change, and given adequate notice and reason, the Advisory Panel will work with scholarship recipients to ensure recipients are able to attend the conference.

  • This field is for validation purposes and should be left unchanged.
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