AADMD Student Chapter Application

Application to Establish an AADMD Student Chapter
Organizational Information
Name of Student Chapter*
Professional Disciplines Represented*

MedicineDentistryBoth
Affiliate Medical and/or Dental School*
Date of First Official Meeting*

MonthDayYear
Student Chapter Officers

Medical Chair
Medical Chair

First NameLast Name
Medical Chair
example@example.com

Dental Chair
Dental Chair

First NameLast Name
Dental Chair
example@example.com

Director of Membership
Director of Membership

First NameLast Name
Director of Membership
example@example.com

Director of Programs
Director of Programs

First NameLast Name
Director of Programs
example@example.com

Director of Public Relations
Director of Public Relations

First NameLast Name
Director of Public Relations
example@example.com

Secretary
Secretary

First NameLast Name
Secretary
example@example.com

Other Chapter Officer 1
Role/Title
First NameLast Name
example@example.com

Other Chapter Officer 2
Role/Title
First NameLast Name
example@example.com

Other Chapter Officer 3
Role/Title
First NameLast Name
example@example.com

Other Chapter Officer 4
Role/Title
First NameLast Name
example@example.com

Other Chapter Officer 5
Role/Title
First NameLast Name
example@example.com

END
Faculty Advisors

Primary Faculty Advisor
Primary Faculty Advisor*

First NameLast Name
Primary Faculty Advisor*
example@example.com

Faculty Advisor 2
Faculty Advisor 2

First NameLast Name
Faculty Advisor 2
example@example.com

Faculty Advisor 3
Faculty Advisor 3

First NameLast Name
Faculty Advisor 3
example@example.com

END
Primary Student Contact
Name of Primary AADMD Student Chapter Officer*

First NameLast Name
Email of Primary AADMD Student Chapter Officer*
example@example.com

AADMD Student Chapter Memorandum of Understanding (MOU)
Introduction

The American Academy of Developmental Medicine and Dentistry, hereinafter referred to asthe AADMD, was founded in 2002 with the stated mission of improving the quality ofhealthcare for individuals with neurodevelopmental disorders and intellectual disabilities.
Name of Student Chapter*
hereinafter referred to as the AADMD Student Chapter or Student Chapter, was organized on
Date of First Official Student Chapter Meeting*

MonthDayYear
Date
for the purpose of promoting the mission of the AADMD to the students and faculty of
Affiliate Medical and/or Dental School*
The AADMD anticipates an ongoing affiliation with the above-named AADMD Student Chapter.

This memorandum of understanding, hereinafter referred to as the MOU, shall serve to memorialize the terms of the affiliation between the AADMD and the above-named AADMD Student Chapter in promoting the mission of the AADMD.
Terms of Agreement
Section I - Mission of the Student Chapter
1. The above-named AADMD Student Chapter is being formed primarily for the purpose of promoting the mission of the AADMD through student leadership, advocacy, and action; the members of this Student Chapter will actively encourage their student and resident colleagues to improve and enhance their knowledge in the care of individuals with neurodevelopmental disorders and intellectual disabilities (ND/ID).
Section II -Organization and Function of the AADMD Student Sub-Committee
1. The AADMD has established a Student Sub-Committee as part of the AADMD’s Membership Committee, and the Student Sub-Committee will respond and directly report to the AADMD Vice President for Membership.
2. The AADMD Student Sub-Committee will be comprised of a maximum of three (3) medical students and three (3) dental students who are in good standing at their respective medical and dental schools, and a maximum of four (4) AADMD-member advisors who are members in good standing with the AADMD. The four AADMD- member advisors will include:
  1. The Vice President of the AADMD for Membership
  2. One additional member of the Executive Board
  3. Two active members of the AADMD.
3. Any member of the AADMD who wishes to serve as an advisor to the AADMD Student Sub-Committee will submit an application to the Vice President for Membership; the application will then be reviewed and submitted by the Vice President for Membership to the Executive Board for approval; the term of an advisor to the Student Sub-Committee shall be either one year, two years, or longer as needed, by mutual agreement of the member and the Executive Board.
4. The functions of the AADMD Student Sub-Committee will include but not be limited to:
  1. Supporting and assisting the AADMD Vice President in his / her role as the principle liaison between the AADMD Student Chapters and the AADMD Executive Board
  2. Assist with Student Chapter recognition and program development
  3. Assure that any activity by the Student Chapters, which uses the name, logo or any representation of the AADMD, is carried out in a professional, dignified and appropriate manner
5. The AADMD Student Sub-Committee will be co-chaired by one student from each discipline – medicine and dentistry. Student Subcommittee Student Chairs and members will be appointed annually by the Student Membership Sub-Committee.
6. The AADMD Student Sub-Committee may communicate with, and provide support to its Student Chapters via teleconferencing and videoconferencing technology provided by AADMD.
7. The AADMD will make a page on its website available for Student Sub-Committee and Student Chapter information, and the content of that web page will be subject to review and editing by the AADMD Vice President for Membership.
8. When the minimal requirements outlined in Section III have been fulfilled, the Student Chapter shall submit an application to the AADMD Student Sub-Committee for review, and the AADMD Vice President for Membership shall present the application to the AADMD Executive Board for a formal vote of approval.
9. The principle liaison between the AADMD and the AADMD Student Sub-Committee will be the AADMD Vice President for Membership.
Section III - Requirements for the Formation of an AADMD Student Chapter
1. A Student Chapter can be formed by medical students, residents, and fellows, dental students, residents, and fellows, or associated allied healthcare students, residents, and fellows, such as dental hygienists, nutritionists, occupational and physical therapists, speech pathologists, nurse practitioners, physicians’ assistants, registered nurse anesthetists, premedical or predental students, or other healthcare professional students.
2. Each AADMD Student Chapter may include a Medical Chair, a Dental Chair, or an Associate Student Chair. Other optional officers may be appointed or elected as needed by the Student Chapter. The minimum number of students required to form a chapter is one (1).
3. Each AADMD Student Chapter should strive for broad representation among its membership by recruiting medical, dental, or associated student members from all academic levels – PDY-1 through PGY-8, etc.
4. Each AADMD Student Chapter should recruit at least one (1) faculty advisor from the associated college, school, or university; the faculty advisor(s) should be encouraged to join the AADMD.
5. The AADMD Student Chapter should be recognized and approved by the college, university, or school with which it is affiliated, according to the rules and regulations governing student organizations at that school.
6. Representatives from the AADMD Student Chapter are expected to participate in the monthly meetings of the AADMD Student Sub-Committee.
7. Members of AADMD Student Chapters – individually or as a group – are encouraged to develop projects under the supervision of their local faculty advisor(s) or their AADMD mentors, such as patient care projects, lectures, clinical or other research projects, etc.
8. Each AADMD Student Chapter will complete a long range plan by May 1st of each year for the following year’s activities and submit that plan to the AADMD Student Sub-Committee no later than May 31st.
9. Each AADMD Student Chapter will submit the minutes of their monthly meeting in the form of a report to the AADMD Student Sub-Committee; a Sub-Committee report will be presented to the AADMD Executive Board by the Vice President for Membership.
10. A Student Chapter that, once established, fails to meet the minimal requirements will have one academic year to correct the situation before being assigned an inactive status.
11. Each AADMD Student Chapter will conduct its meetings according to Robert’s Rules of Order.
Section IV - Revocation of a Student Chapter and / or Student Chapter Member
1. Any Student Chapter or Student Chapter member found to be engaging in
  unprofessional or unlawful behavior shall have their chapter status or membership status immediately revoked by the AADMD Vice President for Membership. The Student Chapter or Student Chapter member may appeal the revocation to a three-member appeals panel comprised of those AADMD Student Sub-Committee advisors other than the Vice President for Membership. The appeals panel will then review and rule on the appeal. If the ruling is unfavorable to the appellant chapter or student, a final appeal may be made to the Executive Board. The ruling of the Executive Board is final.
Section V – Special Olympics Grant
1. Each AADMD Student/Resident Chapter should endeavor to engage in as many of the following activities as possible:
  1. Increase awareness of the need of healthcare improvement for adults
    intellectual and developmental disabilities.
  2. Advocate for medical and/or dental school curriculum enhancement involving adults with intellectual and developmental disabilities.
  3. Volunteer at a Special Olympics sports event or Special Olympics Healthy Athletes event
  4. Advocate for more medical and dental services for adults with intellectual and developmental disabilities at school-affiliated clinics.
  5. Advance or support AMA Resolution 805-I-10 which calls for the federal
    government to declare people with Intellectual Disabilities as a Medically
    Underserved Population.
The terms of this MOU are mutually agreed upon by:
Name of Primary AADMD Student Chapter Officer*

First NameLast Name
Email of Primary AADMD Student Chapter Officer*
example@example.com

AADMD Student Chapter General Member Roster
Name of Student Chapter*
Affiliate Medical and/or Dental School*
Student Chapter Member Information

Level of Study examples include: M1, M2, D1, D2
NOTE: Active chapters must send an updated roster including contact information of members including faculty to the AADMD VP for Membership (srcinfo@aadmd.org) by October 1st.
Contact Information:

Sage Casswell - srcinfo@aadmd.org
Should be Empty:

Application to Establish an AADMD Student Chapter

Organizational Information

Student Chapter Officers

Faculty Advisors

Primary Student Contact

AADMD Student Chapter Memorandum of Understanding (MOU)

Introduction

Terms of Agreement

Section I - Mission of the Student Chapter

Section II -Organization and Function of the AADMD Student Sub-Committee

Section III - Requirements for the Formation of an AADMD Student Chapter

Section IV - Revocation of a Student Chapter and / or Student Chapter Member

Section V – Special Olympics Grant

The terms of this MOU are mutually agreed upon by:

AADMD Student Chapter General Member Roster

Student Chapter Member Information

Contact Information: