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
Preferred Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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 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 currently be a:
1. High School, College, Professional or Olympic team physician; OR
2. Performance Arts company physician; OR
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/University, 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).
Letter of Nomination

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.
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Letter of Support

You must have a letter of support from a current AOASM member in good standing. Please upload letter.
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Check button if you plan to send Letter of Recommendation and/or Letter of Support directly to AOASM Executive Director at mhelms@aoasm.org

Relative Criteria

Applicant needs a minimum of thirty (30) points since completion of primary residency program. Points should NOT come from one area.

Completion of AOA/ACGME approved Primary Care Sports Medicine Fellowship (8 points).

Rows	Institution	Program Director	Date(s)
Fellowship Program

Author of article published in The Clinical Journal of Sports Medicine or another peer reviewed journal in Sports Medicine i.e. BJSM, MSSE. Please upload a copy of the article(s). (Lead Author: 4 points, Co-author: 2 points. 8 points maximum)

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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. (2 points per chapter. 4 points maximum).
Lead author in sports medicine related topic or case study in on-line or print journals. (2 points per chapter. 4 points maximum).
AOASM Board Service.

You will receive 2 points for every year of service on the Board and an additional 1 point for any years of service as a member of the Executive Committee. (8 points maximum)
AOASM Board Member (2 points/year of service)
Please submit number of years in office
AOASM Executive Committee Member (1 additional points/year of service)
Please submit number of years in office
AOASM Committee Member, Liaison (e.g. NATA. ACSM, etc), or other approved leadership roles (1 point per year of service, 1 additional point per year of service as chair. 4 points maximum).
Attendance at Annual AOASM Clinical Conference (2 points per conference)
Submit years attended (i.e. 2015, 2017, 2022)
Presentation at the Annual AOASM Clinical Conference (2 points per lecture, 3 points for lead workshop presentation)
Attendance at AOASM Fall Conference (OMED) (1 point per conference)
Submit years attended (i.e. 2015, 2017, 2022)
Presentation at the AOASM Fall Conference (2 points per lecture)
Number of years in sports medicine practice starting after 5 years post fellowship (1 point per year)
Please submit number of years in sports medicine practice
Served an ACGME approved Sports Medicine Fellowship program in the following capacities (1 point per year of service. 2 points per year maximum)
Please provide a list of your ACGME approved Sports Medicine Fellowship program involvement below, if applicable.

Relative Criteria Points Review. Applicant needs a minimum of 30 points since completion of primary residency program. Points should not come from one area.

Rows	Points
Completion Sports Medicine Fellowship (8 points)
Journal Article Author (8 points max)
Textbook/Chapter Author/Editor (4 points max max)
Lead author in sports med topic or case study (4 points max)
AOASM Board Member (2 points/year)
AOASM Executive Committee (1 point/year
AOASM Committee Member, Liaison, or other leadership role (1 point/year. 4 points max))
Attendance at Annual AOASM Clinical Conference (2 points/conference)
Presenter at AOASM Clinical Conference (2 points/lecture. 1 point/workshop
Attendance at AOASM Fall Conference (OMED) (1 points/conference)
Presenter at AOASM Fall Conference (2 points/lecture)
Years of Sports Medicine Practice (1 points/year after 5 years)
Sports Medicine Fellowship Service (1 point/year. 2 points/year max)
Total (sum of all points earned)

Please provide a list of other relevant Clinical Sports Medicine activities for the Committee to consider, if applicable.

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

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

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.