AOA Membership Candidate Profile Application for Fellowship Directors and Service Line Chiefs

AOA Membership Application

Fellowship Directors & Service Line Chiefs - Class of 2026
Thank you for your interest in becoming a member of the American Orthopaedic Association. To help the Membership Committee evaluate your candidacy, please provide the supplemental information listed below. Because CVs vary in format and content, this step ensures we have complete details for all areas under consideration for AOA membership.
I am applying as a:*

Fellowship DirectorService Line Chief
Name *

First NameMiddle NameLast Name
Designation Credentials *
Current Title/Position*
Institution Name*
Address Type*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Personal Email*
example@example.com
Preferred Email*
Mobile Phone Number*
Please enter a valid phone number.
Practice Type*

Full-time academicHospital/System based employeeMilitary/Government employeeNot applicablePart-time academicPrivate PracticePrivate Practice with academicRetiredOther
Sub-Specialty*
Clinical Practice Start Date - please indicate the date on which you performed your first clinical duties as an unsupervised orthopaedic surgeon (office or surgery). *

MonthDayYear
Date
Date of Birth*

MonthDayYear
Date
Ethnicity*

African AmericanAsianCaucasianHispanic LatinoMultiracialNative AmericanPrefer not to answerNon Hispanic LatinoOther
Gender*
Personal Statement*
Why are you interested in becoming a fellow of the American Orthopaedic Association?
Professional Positions Held: Please list all work positions held since completion of orthopaedic training, including title(s), institution(s), and dates the position was held. Examples include Instructor/Assistant Professor, Associate Professor, Associate Program Director, Fellowship Director, Residency Program Director, Division Chief, Hospital based leadership, Professor, Vice chair, Managing Partner/Leader of Private Practice Group or Service Line, Department Chair, CEO, Chief of Orthopaedic Surgery for large group practice. Military service should be included as well. For non-academic orthopaedic surgeons consider the role in group or health care system.*
Leadership in Orthopaedics: Please include title, position and dates for positions in orthopaedic related entities such as regional, state or national orthopaedic or medical society leadership, such as non-compensated and/or elected roles as Officer (president, vice president, secretary, treasurer), Board or Committee level or Group Orthopaedic Leadership such as CEO, Officer, senior management or leadership position.*
Non-Orthopaedic Medical/Institutional/Community Leadership Experience: Please include title, position and dates for significant participation/leadership positions held in non-orthopaedic medical organizations. Examples include Hospital committees, medical boards, chief medical officer, chief quality officer, county medical societies, medical mission work, and chair of state council or commission or governor’s council with medical-health purpose, medical school and university committees and engagement, sports team coverage.*
Non-Medical Community Leadership Experience: Please include title, position and dates for non-medical community and institutional leadership roles such as non-medical military, civic service, school, and religious groups (church leadership, school board, rotary, PTA, etc.). Or service, for example, on committees, curriculum committees, civic organizations, or public office.*
Education: Include courses taught, curriculum developed, creation of patient educational materials, journals reviewed, podcasts developed/hosted.*
Peer Reviewed Publications, Book Chapters, and Other: Consider refereed articles, book chapters, book editor, journal editor, journal reviewer, national podium presentations, and poster exhibits. *
Honors and Awards: Only include those honors received after medical school; do not include “best doctor” or other marketing/promotional awards. Examples include National or International awards or honors, other non-AOA traveling fellowship, departmental awards, institutional or society awards, humanitarian, mentorship and education awards.*
Mentorship: Include mentorship or onboarding of younger partners; pipeline programs such as improving diversity; advising high school, college, medical or health profession students; participation on mentorship committee. *
Research Support/Grant: Principal investigator or named co-investigator should be stated. Titles, sources, amounts, and dates should be included. Types of support considered include Institutional, Industrial, Federal grant as PI or CO-PI (NIH, CDC, VA, etc.), National peer reviewed grants.*
AOA Activities

Please list all AOA activities in which you have participated, including dates. This includes but is not limited to attendance at AOA annual or regional meetings, AOA leadership programs (including traveling fellowships), participation in the Resident Leadership Forum (RLF) and the Emerging Leaders Program (ELP), committee participation, CORD membership/participation, and Own the Bone program participation.
AOA Annual Leadership Meeting Participation (list years)
C. McCollister Evarts Resident Leadership Forum (RLF) Participation (list years)
[Scott D. Boden] Emerging Leaders Forum (ELF) Participation (list years)
AOA Regional Meeting Participation (list years)
Leadership Education module participant (i.e. AOA | USC APEX Leadership Certificate Program, AOA-Kellogg series, Leadership Immersion Series, and/or AOA Regional Leadership Meetings) (list name and year)
CORD Conference Participation (list years)
Program champion/key contributor in institution’s implementation of Own the Bone Program (list years)
Traveling Fellowship — selection and participation as a fellow in ABC, NATF, ASG, and/or JOA Traveling Fellowship Program (list name and year)
Committee Participation (list committees and years)
Other AOA Participation (list names and years)
Upload Letter of Recommendation #1*

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Upload Letter of Recommendation #2*

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Upload CV*

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