Essay Contest Application Form The deadline for submissions is March 15. Learn more about the Hope Babette Tang Humanism in Healthcare Essay Contest. If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required First Name Last Name Address 1 Address 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPuerto Rico Zip / Post Code Phone Email School/ Institution Name Medical/Nursing Student * MedicineNursing Year in School 1234 Where did you hear about the essay contest? * Attach your essay Do not include your name or school name anywhere within the essay document. Terms and Conditions By submitting my essay I signify that I agree to the Arnold P. Gold Foundation Essay Contest terms and conditions: I am committed to protecting the right to privacy of patients and others. I have changed names where applicable, and have omitted or altered other identifying characteristics of individuals and contexts within my essay. I verify that this essay meets the ethical and HIPAA requirements of my educational institution and have obtained any necessary permissions to submit this essay. I grant The Arnold P. Gold Foundation permission to publish all or parts of my essay on their website, in Academic Medicine, the Journal of Professional Nursing or other academic journal and in other venues to promote the Essay contest. I signify that I am the sole author of this essay, that all sources of information have been properly acknowledged, and that it has not been published elsewhere. The Gold Foundation reserves the right to disallow essays based on editorial, ethical or other considerations.