AADPRT Committee/Caucus Interest Form

AADPRT Committee/Caucus Interest Form

AADPRT's committees and caucuses are working groups tasked with initiatives integral to AADPRT's operation and development. Active participation by committee and caucus members in meetings and initiatives is required.

Please complete this form to share your interest in being an active, involved committee/caucus member who will help shape AADPRT's future.
Your Name*

First NameLast Name
Your Email*
example@example.com
Program name*
Your role*

Physician/Psychologist (TD, ATD, Chair, Professor, etc.)Program Administrator (Coordinator)
Region*

Region I: New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, Canada (Quebec, Toronto, Ontario))Region II: New YorkRegion III: Mid-Atlantic (Delaware, Maryland, New Jersey, Pennsylvania, Washington D.C.)Region IV: Midwest (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin)Region V: Southeast (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, West Virginia)Region VI: CaliforniaRegion VII: Far West (Alaska, Arizona, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming, Canada (Vancouver, Winnipeg, Manitoba, Alberta, British Columbia, Saskatchewan))
Resident/fellowship program size*

Small (<15 trainees)Medium (15-40 trainees)Large (>40 trainees)
Program type*

University-basedCommunity-basedVAOther (please specify)
Program setting*

RuralUrbanSuburban
I am interested in serving on the following committees (select NO MORE THAN THREE (3)):

AddictionsAssessmentCurriculumDevelopmentInformation ManagementInternational Medical Graduates (IMG)Justice, Equity, Diversity, Inclusion (J.E.D.I.)MembershipMentorship & Professional GrowthNeuroscience EducationOrganizational EquityPsychotherapyRecruitmentWellbeing/BurnoutWorkforce
I am interested in serving on the following PA committees (select NO MORE THAN THREE (3)):

CommunicationLucille Fusaro Meinsler Program Administrator AwardNew Member LiaisonProfessional Development and TAGMEProgram PlanningWellness
I am interested in joining the following caucuses (select NO MORE THAN THREE (3)):

Assistant/Associate Training Directors (ATDs only)Child and Adolescent Psychiatry (CAP TD/ATDs only)Combined ProgramsCommunity ProgramsDirectors of Small ProgramsGlobal PsychiatryHumanities in MedicineIntegrated CareNew ProgramsRegional CaucusRural ProgramsSubspecialtyTriple Board/AACAPVAVice Chair
I am interested in serving on the following awards/fellowship committee:

AAAP-AADPRT Visiting Scholars Award in Addiction EducationAADPRT Lifetime Service AwardDr. Iverson Bell, Jr. Faculty FellowshipGeorge Ginsberg FellowshipNyapati Rao & Francis Lu International Medical Graduate (IMG) FellowshipPeter Henderson MD Memorial Paper Award (CAP psychiatrists only)Poster
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