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About
Board of Directors & Councillors
Awards
Committees
Calendar
New York ACEP News
Advocacy
Workplace Violence Prevention Alliance
Advocacy Day
New York Emergency Medicine Political Action Committee
Action Alerts
Events
Scientific Assembly
ED Practice Innovations Conference
Medical Student Symposium
EM Resident Career Day
Resident Research Conference
Industry Opportunities
Member Benefits
Online CME
Leadership and Development Fellowship
Academy of Clinical Educators
Opportunities for Women in Leadership
Speaker Directory
Resources
Join New York ACEP
Empire State EPIC
Current Issue
Previous Issues
Newsletter Advertising
Search for:
Search Button
Leadership and Development Fellowship Application
Download A
Sample Letter of Support
Name
(Required)
First
Last
Credentials
(Required)
MD
DO
FACEP
Other Credentials
Home Address
(Required)
Email
(Required)
Phone
Practice Site
(Required)
Residency Graduation Year
(Required)
Years as an ACEP Member
(Required)
I affirm that I am and will remain a New York ACEP member practicing in New York for the duration of this program.
(Required)
Yes
I affirm my ability to participate in all designated elements of the Leadership and Development Program.
(Required)
Yes
CV
(Required)
Max. file size: 128 MB.
Letter of Support
(Required)
Max. file size: 128 MB.
Signed Department Leadership Commitment Form
(Required)
Max. file size: 128 MB.
A templated letter is available on the Leadership and Advocacy webpage, or you may upload your own version.
Identify how you would benefit from the NYACEP Leadership and Development Fellowship program.
(Required)
Describe your interests in political action, advocacy, and/or leadership
(Required)
Describe a current regulation, bill, or issue in NY State that inspires you to advocate for or against it for NY emergency physicians and patients
(Required)
Describe prior leadership and/or service experience
(Required)
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