We wish to showcase our new incoming residents and celebrate their success through our social media channels and will be posting individual profiles for each resident choosing to participate.

We know many of you prefer to keep your privacy so if you do not complete the form we will not feature you. If you are interested in participating, please complete the form below so that we may prepare a post featuring you.

Your Information
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For example: Jane D. Smith
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Spotlight Post...
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i.e.: MD, DO, PsyD, etc.
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Select two questions from the lists below to provide some trivia about yourself

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If so please provide us with your Instagram account name, otherwise leave it blank.
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Photo Submission
You can select to submit your own photo or choose to use your professional headshot. If you upload your own photo, please ensure it is at least 900px in length and width. You should be the focal point if other people are included in your photo. If there is anyone under 18 in the photo provided you must complete a photo release form (even if the minors are your children).
Make sure the file is at least 900px (length and width). Press upload before submitting the form.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

Don't forget to submit a consent form for each minor in the photo. Click the button below to launch the media consent form (this link will open in a new tab).
For the "Name of the event or promotional purpose" field, please enter "Resident Profile Social Media posts"

NCHS Media Consent Form

We will not publish your post until we receive confirmation from marketing that the release form has been received.