Surekha and Deepak Kumar, MD, Endowed Fund for Emerging Physician Leaders and Advocates
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| Application Deadline: February 16, 2026
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| 2026 Grant Awardees will be introduced the OSMA Foundation Reception on the evening of Friday, April 10, 2026. Awardees are encouraged to attend the OSMA Annual Meeting to be held April 10-12, 2026 at the Renaissance Columbus Westerville - Polaris Hotel.
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| Questions? Contact foundation@osma.org
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SECTION 1 - Applicant Information
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| First Name | |
| Middle Name | |
| Last Name | |
| Informal Name | |
| Birthdate | ?
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| Gender | |
| Ethnicity/Race (optional) | |
| Email | |
| Cell Phone | |
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| Home Address | |
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| City | |
| State | Zip |
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| Current Role | |
| Hospital/Practice Affiliation | |
| Specialty | |
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*Applicants are encouraged to use all the space provided to answer each question fully.
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SECTION 2 - Leadership Opportunity & Background
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Describe the leadership or advocacy opportunity you are applying for, including the program name, key components, skills you expect to gain, and the program format?
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Why do you want to pursue this opportunity, and how will it support your development as a physician leader?
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Briefly describe any leadership, advocacy, or community involvement experiences you’ve had so far.
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Link to program information (optional)
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SECTION 3 - Timeline & Expectations
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When do you expect to complete this opportunity? *Must be completed by February 2027.
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Participation Agreement — OSMA Annual Meeting
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By applying, I understand that if awarded this grant, I am expected to attend and share my experience during the OSMA Annual Meeting in April 2-4, 2027. Select one option
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Please check this box to confirm that you will participate in an OSMA Foundation interview/spotlight featured on the website and/or social media.
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SECTION 4 - Budget & Funding
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What is the total amount you are requesting? (max request amount is $3,500)
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Provide a simple budget outline for your opportunity (examples: tuition/registration, travel, lodging, materials).
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Are you receiving or seeking any other funding for this opportunity?
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If "Yes" - please explain
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SECTION 5 - Final Items
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Submit a copy of your CV to foundation@osma.org to complete your application.
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By checking this box, I certify that the information provided is accurate.
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