AOASM Fellow Application

Fellow Application

Thank you for your interest in becoming an AOASM Fellow. Please fill out the form below and submit payment to be considered.
Applicant Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
AOA Member Number*
Curriculum Vitae*

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Recent Photograph*

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Absolute Criteria

You must be a full physician member of the AOASM for five (5) consecutive years at the time of application. Membership during your Fellowship year can be counted as the first year. Residency years do not qualify as physician members.

You must hold current board certification by primary board at the time of application. *

Rows	Institution	Date(s)
Medical School
Residency Training Program
Specialty Board Certification (list specialty in next column)

You must have completed an AOA/ACGME Approved Primary Care Sports Medicine Fellowship .*

Rows	Institution	Program Director	Date(s)
Fellowship Program

You must currently be a:
1. High School, College, Professional or Olympic team physician;
2. Performance Arts company physician;
3. Lead Medical Director for at least 5 mass events; OR
4. Program Director/ Asst. Program Director/ Core Faculty for an ACGME approved Sports Medicine Fellowship.
Please provide information about these activities below.
Please provide a list of your High School, College, Professional, or Olympic team physician activities, if applicable.
Please provide a list of your Performance Arts Company physician activities, if applicable.
Please provide a list of your Lead Medical Director for mass events activities, if applicable. Please include five (5).
I have served an ACGME approved Sports Medicine Fellowship program in the following capacities, if applicable:

Program DirectorAssistant Program DirectorCore Faculty Member
Please provide a list of your ACGME approved Sports Medicine Fellowship program involvement below, if applicable.
Please provide a list of other relevant Clinical Sports Medicine activities for the Committee to consider, if applicable.
You must have a current CAQ in Sports Medicine from ABMS or AOA conjoint board at the time of application. Please upload proof of CAQ.*

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You must be nominated by a current AOASM Fellow and have a letter of recommendation from the nominating physician who is a current AOASM member. Please upload letter below.

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Check button if you plan to send LOR directly to AOASM Executive Director at mhelms@aoasm.org

I plan to send LOR to AOASM via email.

Relative Criteria

Applicant needs thirty (30) points within a seven-year span.
Author of article published in The Clinical Journal of Sports Medicine (8 points for lead author; 4 points for co-author) or another peer reviewed journal in Sports Medicine (6 points for lead author; 3 points for co- author) i.e. BJSM, MSSE. Please upload a copy of the article(s)

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Editor/ author of chapter(s) in Sports Medicine textbook or Sports Medicine chapter(s) in other books. Please submit text name, primary author of the text, publication date and publisher. (6 points).
AOASM Board Member (2 points/year of service).
Please submit number of years in office
AOASM Committee Member, Liaison, or other approved leadership roles (1 point per year of service).
Registrant at Annual AOASM Clinical Conference (2 points per conference)
Submit years attended (i.e. 2015, 2017, 2022)
Presentation at the Annual AOASM Clinical Conference (3 points per presentation)
Registrant at AOASM Fall Conference (2 points per conference)
Submit years attended (i.e. 2015, 2017, 2022)
Presentation at the AOASM Fall Conference (3 points per presentation)

Relative Criteria Points Review

Rows	Points
Journal Article Author (8 points max)
Textbook/Chapter Author/Editor (6 points max)
AOASM Board Member (2 points/year)
AOASM Committee Member, Liaison, or other leadership role (1 point/year)
Registrant at Annual AOASM Clinical Conference (2 points/conference)
Presenter at AOASM Clinical Conference (3 points/presentation)
Registrant at AOASSM Fall Conference (2 points/conference)
Presenter at AOASM Fall Conference (3 points/presentation)
Years of Sports Medicine Practice (2 points/year after 5 years)
Total (sum of all points earned)

Affirmation
I attest that the information provided is accurate and honest. I realize if an investigation reveals that the information I have supplied is untrue, I may forfeit the award of Fellow along with all fees paid. Please sign below

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Payment Information
Upon notice of approval by AOASM, the candidate shall be billed an additional $250.00 to cover the remainder of the Award of Fellow application fee.
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AOASM Fellow Application Fee
Non-refundable application fee (50%)

$250.00 Quantity

Total

$0.00
Should be Empty:

Fellow Application

Applicant Information

Absolute Criteria

Relative Criteria

Affirmation

Payment Information