Faculty Profile Information Form

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Faculty Online Profile Information Form

GENERAL INFO

First Name(*)

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Middle Initial (*)

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Last Name(*)

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Please list your academic degrees

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Pediatric Division(*)

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Please list any clinical or research programs you are a part of

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Please select one

Female

Male

Prefer not to say

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Please list all languages that you speak

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TITLES

Please list your academic title

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Please list any other UAB titles you have (endowed chair, membership in a center or institute, etc.)

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Please list your Children's titles

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CONTACT INFO

Email(*)

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Clinic Address

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Mailing Address

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Appointment Phone Number

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Office Phone Number

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Office Fax Number

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EDUCATION

Undergraduate

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Graduate

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Medical School

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TRAINING & PROFESSIONAL INTERESTS

Internship

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Residency (where and specialty)

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Fellowship (where and specialty)

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Certifications

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Please list your clinical interests

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Please list your research interests

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Please list any professional organization you are a member of and any leadership roles you hold

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Please list your honors and awards

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If you served in the military, please let us know what branch

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Please enter any additional information you would like to include in your faculty profile that was not covered above

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Headshot Request

Headshot sessions are held on the 3rd Thursday of each month from 11:30 a.m. to 1:30 p.m. in our mini photo studio located on the Ground Floor of the McWane Building across from Clinic 15.

If you are unable to attend one of these sessions and need to schedule an individual headshot session, please email Denise McGill, photographer for Children's of Alabama, and she will work with you to schedule one.

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Faculty Online Profile Information Form