CORD RAF 2025 - Application Form

Application Form

Please complete the information below to apply. If you are NOT accepted for the Fellowship the $1,500 course fee will be refunded. There are a maximum of 25 applicants that will be accepted.
This year-long course will combine in-person and asynchronous experiences for faculty to learn more about the nuts and bolts of program leadership.

Any current faculty or fellow is welcome to apply, whether you currently are in residency leadership or seeking to make that transition. You must hold an active CORD membership to apply. Cost of this course is $1,500.

The course consists of three in-person sessions, pre-days at CORD AA 2025, ACEP Scientific Assembly 2025, and CORD AA 2026. Asynchronous discussion through a web platform will occur between these meetings monthly.

The deadline for submission is December 18, 2024, at 11:59 PM CST.

All uploads MUST be included with the application. Incomplete applications will not be accepted.
Full Name*

First NameLast NameDegree
Institution*
Email*
example@example.com
Cell Phone*
Years in Practice:*
Statement of Interest (1000 words or less)*

0/1000
Letter of Support from Chief/Chair*

MUST be included with application
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Letter of Support from Program Director (if applicable)

*If you are currently in residency leadership or a fellow, please include a letter of support from your current program director.
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Curriculum Vitae*

MUST be included with application
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Residency Administrative Fellowship Registration Fee
$1,500.00

Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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