HIVMA : Minority Clinical Fellowship

Number of HIV Patients
	% Female
	% Asian
	% Black/African-American
	% Hispanic or Latin
	% Native American or Alaskan Native
	% White/Caucasian
	% Other
HIV subpopulations of interest:	Men Who Have Sex w/ Men (MSM) Adolescents Pregnant Women Children

About how many HIV patients might the clinical fellow be managing?
Will fellows have access to HIV inpatient clinical care?
Yes No
How many fellows can your institution support?
Assuming funding from HIVMA to cover salary/benefits, will your institution be able to offer the candidate an employee benefits package?
Yes No
Will fellows have access to other HIV medical education opportunities such as lectures, case studies, etc?
Yes No
Does your institution have links to other clinics/programs at which candidates may spend up to 2 months of their fellowship?
Yes No
How many HIV physicians are on staff at this institution?
How many HIV sub-specialists are on staff?
Obstetrics/Gynecology
Gastroenterology
Hematology-Oncology

HIVMA Clinical Fellowship Program Sponsor Registration

What is the full name of the proposed mentor for this program (if known)?
What is his/her title?