AMSA.ORG
STUDENTS
PARTNERSHIPS
AMSA FOUNDATION
Skip to content
AMSA Portal
On Call Blog
News & Resources
Join
Chapter Hub
About
About AMSA
History
Why AMSA?
Leadership & Staff
National Leadership
National Office Staff
Governance & Politics
Constitution & Bylaws
Strategic Framework
House of Delegates
Resolutions
Committees
Delegates
Membership
Renew or Join
Member Center
Membership Leaders
Chapter Officer Hub
Chapter Officer Marketplace
Chapter Requests Form
Discounts
Become a Leader
Board of Trustees
Membership Directors
Chapter Officers
AMSA Academy Leaders
Action Committee and Campaign Leaders
IFMSA Advisor
Editorial Board
National Leadership Opportunities
Get AMSA ID
FAQs
Academy
About AMSA Academy
Research Directory
Scholars Programs
Mentorship Program
Advocacy Mentorship Sprint
Pathway to Medical School
Reproductive Health Mentorship Sprints
Reproductive Health Project
Residency Prep Series
HEART-IM
International Passport Program
Life + Leadership
Advocacy
About AMSA Advocacy
AMSA Code Blue
Digital Rural Health Project
Rural Ready Mini-Summit 2025
Action Committees
Community & Public Health
Gender & Sexuality
Global Health
Health Policy Team
Medical Education Team
Race, Ethnicity and Culture in Health
Wellness & Student Life
Activism Resources
Events
Calendar
Annual Convention
Digital Health Innovation Festival
Partners
Partner with AMSA
Exhibit
Advertise
Benefits Partners
Institutional Partners
Partners Marketplace
Specs & Submission Forms
Faculty Advisors
Become an AMSA Ally
Grants
Support
Join Our Movement
AMSA Swag Shop
AMSA Foundation
AMSA Alumni Network
Contact Us!
I AM A
Student
University Leader / Faculty Member
Alumni
Business
Donor
LOOKING TO
Advocate for issues I care about
Prepare for what's next
Amplify my learning on specific topics
Find a mentor or a coach
Learn to lead
Learn more about how AMSA can support our institution
Fund AMSA membership to an incoming class
Speak at or attend AMSA National convention
Connect to discuss creative partnerships
Donate to AMSA!
Connect with medical students
Find creative partnerships to showcase my offerings
Support the Work fo AMSA
GO
Step
1
of
5
20%
Institution
(Required)
Form completed by:
Name
(Required)
First
Middle
Last
Suffix
Title
(Required)
Email
(Required)
Phone
(Required)
Alternate contact for follow-up
Name
First
Middle
Last
Suffix
Title
Email
Phone
CAPTCHA
** This project is funded by Arnold Ventures
Submission Detail
For each topic below, please fill in the appropriate original policy implementation date for each. If you do not have a policy that covers a topic, leave the date blank on that topic to indicate that no policy has been implemented. It is also possible that one policy may cover multiple of these topics, which you can clarify further in the additional comments section below as needed. If you would like more detailed information regarding which policies we are requesting, please refer to the
“Submission Guidance” document here
.
Note that you may submit policies from affiliated hospitals, whether or not they are owned by the medical school.
Industry-funded gifts policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Industry-funded meals policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Industry-funded speaking relationships policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Industry-support of ACGME-accredited Continuing Medical Education (CME) policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Attendance of industry-sponsored promotional events policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Industry-funded scholarships and awards policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Ghostwriting and honorary authorship policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Consulting and advising relationships policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Access of pharmaceutical sales representatives policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Access of medical device representatives policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Conflict of interest (COI) disclosure policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Existence of an adequate conflict of interest (COI) curriculum policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Extension of conflict of interest funding policies to community affiliates policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
Enforcement and sanctions of policies policy implementation date
Leave date blank if no policy has been implemented to cover this topic.
MM slash DD slash YYYY
If any of the domains above do not apply to your institution, please indicate the domain and explain:
Policy documents
Please attach your policy documents here.
Drop files here or
Select files
Max. file size: 50 MB, Max. files: 10.
Additional comments?
Permission to use your institution's policies
Optional: May we quote portions of these policies for illustrative purposes?
Yes, I agree on behalf of my institution.
AMSA and its PharmFree project may quote portions of our submitted policies for illustrative purposes.
Non-agreement to portion quoting
No, I do not agree.
Optional: May we post your policies on our website as examples for other medical schools?
Yes, I agree on behalf of my institution.
AMSA and its PharmFree project may post my institution's policies on the amsa.org and/or PharmFree Scorecard websites as examples for other medical schools.
Non-agreement to example posting
No, I do not agree.
Communication, monitoring, and adherence
We are interested in understanding how these policies are implemented. We will be producing an aggregated, qualitative report on the process, and would greatly appreciate your responses to the questions below. This is not part of the formal Scorecard assessment;
answers will be kept confidential unless you indicate otherwise.
Please be as detailed as possible.
What challenges have you experienced, if any, with implementation of your policy?
How are questions about policy interpretation resolved? Please describe the process.
What processes are in place to educate faculty, staff, and students about policy contents?
How is policy compliance monitored? Please describe any ways this is accomplished.
How frequently have instances of noncompliance been identified? If any actions have been taken to correct policy noncompliance, please describe the process.
Optional: May we share your responses to these questions on our website?
Yes, I agree.
AMSA and its PharmFree project may share my responses to the Communications, monitoring and adherence questions on the amsa.org and/or PharmFree Scorecard web sites and reports.
Non-agreement to response sharing
No, I do not agree.
Please sign below to indicate the information and policies submitted by me on behalf of my institution is accurate to the best of your knowledge.
Signature
(Required)
** This project is funded by Arnold Ventures
Enable JavaScript to ensure
website accessibility
