DISTRICT RESIDENT CATCH LIAISON
Application Form
Name:
AAP ID#
Residency Program:
Address:
Telephone (Day):
(Evening):
E-mail:
Year of residency training:
Are you planning a chief resident year?
Are you in a combined training program? Identify:
1. Why is community pediatrics important to you? Describe your involvement. (Maximum
300 words)
2. What do you hope to contribute to the Resident Liaison position? (Maximum 300 words)
3. Return this form by e-mail to CATCH-DRL@aap.org. Please attach your CV and a letter of
support from your clinical/career mentor, a faculty member, or a community pediatrician.