Membership Change Form
All major changes to member programs must be submitted in writing to the Fellowship Council office via the Membership Change Form. The Designated Institutional Official (DIO), Chair and either the Program Director (PD) or the Associate Program Director (APD) must sign off on all change forms and additional materials submitted with the change form.
Major changes include:
- Change in Program Director
- Change in Faculty Complement
- Change in Number of Positions Available
- Change in Program Designation
- Withdrawal from the Fellowship Council/Program Closure
- Major Change in Rotation/Clinical Volume
- Impact of Other Learners
- Change in Matched or Current Fellow
- Fellow Time Extensions OR Changes to Fellowship Dates (decrease or increase)
Membership Change Review Process
The completed form should be emailed to [email protected].
The information submitted to the Fellowship Council will be reviewed by the Accreditation, Communications and Membership Committees, and/or Board of Directors as applicable.
**Potential triggers for a site visit by the Accreditation Committee include but are not limited to: a change in Program Director, a change in the number of fellows, a significant change in the associate faculty, insufficient case logs, program complaints, failure to address previous citations, and conflicts with the residency program. Please also note that a change in program designation may require closure of the existing program and re-application as a new member for the requested new designation.
Download the Membership Change Form.