Alter Egos submission form
Name
*
First
Last
*
Last
Your Contact Email
*
Are you submitting your own alter-ego or a colleague's?
*
Myself
My colleague
Colleague's Contact Email
*
If we need to follow up with the nominated colleague, do you prefer to remain anonymous or may we use your name as reference?
Yes, you can use my name.
No, please keep my anonymous.
Briefly describe you (or your colleague's) inspiring alter-ego. (100 words or less)
*
0
of 100 max words
File Upload (if you'd like to share photos to be featured in the official UT Health San Antonio social channels)
Drop a file here or click to upload
Choose File
Maximum file size: 3.69MB
I voluntarily give my permission for UT Health Science Center staff to use my submitted information and photo(s) on digital platforms including social media, website, newsletters, and other digital platforms.
*
Yes
No
Submit
If you are human, leave this field blank.
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