1 Start 2 Review 3 Complete SUBMITTED BY Name * Email * Institution/Practice Name * Institution/Practice Location * ACTIVITY TITLE AND DESCRIPTION Activity Title * Activity Description * Please write a short 100-250 word paragraph describing the educational activity. Proposed Activity Format * Please note that all presentations will be recorded for future viewing. Live (e.g., webinar) Prerecorded (e.g., online lecture course) Topic Area * Please select one Primary Topic Area for which this activity best fits: Breast Central Nervous System Digital Health and Informatics Diversity, Equity and Inclusion in Health Care Education & History in Radiation Oncology Gastrointestinal Cancer Genitourinary Cancer Gynecological Cancer Head & Neck Cancer Health Policy Health Services Research Hematologic Malignancies Immunotherapy Lung Cancer Palliative Care Patient Reported Outcomes/Survivorship Patient Safety & Quality Pediatric Cancer Radiation and Cancer Biology Radiation and Cancer Physics Sarcoma and Cutaneous Tumors Other: Topic Area Other: Professional Practice Gap(s) * Please indicate which gap(s) this educational activity serves to fill (select all that apply): Patient safety Clinical research Basic science research Technology and technique Education research Clinical practice Other Patient safety, related to: Clinical research, related to: Basic science research, related to: Technology and technique, related to: Education research, related to: Clinical practice, related to: Other, related to: Leave this field blank
