ANA Ascend Program Application

"*" indicates required fields

Please complete the form below completely. We want to get to know YOU, so please complete the questionnaire without the support or help of any AI-generated responses. The deadline to submit applications is May 15, 2026 at 11:59 PM PDT. Only completed applications will be considered. If you have questions about ANA Ascend, please contact ANA Marketing & Membership Coordinator Nicole Baus at nbaus@myana.org.

Name*

First Last

Year in Medical School or MD-PhD Program in Fall 2026*

Email Address*

If you are an MD-PhD student, are you within one year of starting clerkship as of Fall 2026?

Yes

Institution*

Institution City and State*

City State

Phone Number (Cell number preferred)*

Professional Reference First Name (This person will be contacted to confirm support of your participation in the program.)*

Professional Reference Last Name*

Professional Reference Title*

Professional Reference Email*

Do you have a neurology rotation at your institution?*

Yes

If yes, is it required or optional?*

Required

Optional

We do not have a neurology rotation

What would be most impactful or helpful at this stage to support your neuroscience trajectory?*

What excites you about neurology? Is there a personal or professional experience that excited you in particular?*

Why do you want to participate in ANA Ascend, and what outcomes do you hope to achieve?*

Do you have a neurology mentor? How have they influenced your interest in neurology? If you do not have a neurology mentor, how would you describe your ideal mentor in neurology?*

What is a strength and weakness of the project described in your abstract?*

If selected to participate in ANA Ascend, I agree with the following requirements and aspects of participation:*

I will receive complimentary membership in the ANA for membership year 2026
I will receive a complimentary registration to ANA2026
I will participate in a virtual meeting prior to the Annual Meeting to meet the Ascend cohort and enhance my program participation
I will be required to submit an abstract for ANA2026, and participation in Ascend requires my abstract be accepted
I will be required to attend ANA2026 from October 17-20, 2026, in San Diego and attend suggested educational programming
I will be eligible for travel reimbursement (paid after the Annual Meeting) up to $1,000 to help with expenses related to attending ANA2026

I understand and agree to the program requirements if selected to participate.

My answers in this application are original, accurate, and from me personally. I did not utilize AI to generate responses.

Please upload your CV*

Accepted file types: pdf, Max. file size: 1 MB.