Please fill in the required fields (*) below to request access to the Partners in E program materials.
*State:
*Country:
*Are you currently a student or a resident in training?:
*What is your primary discipline?:
*Does your school/institution currently offer an informatics course? 
*What is your primary interest/need with the Partners in E program? 
*How did you hear about the Partners in E program?:
*In the future, would you participate in a brief survey assessing your use of Partners in E?: