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American Geriatrics Society
Fellowship Application and Instructions

You are eligible for consideration for AGS Fellowship if you are currently an Active Member of the AGS, have been an Active Full Member of the AGS for at least 5 years* and have attended at least 3 Annual Meetings. Fellowship status is awarded according to approval by the AGS Board of Directors.

Instructions: To be considered for the degree of AGS Fellow, an applicant must:

  1. Provide two letters of recommendation by members of the Society in good standing (members for at least three years, Fellows of the Society encouraged) endorsing the applicant's advancement to Fellowship status.
  2. Accrue 20 points as defined by this application.
    • Complete only the items that apply.
    • Do not list identical items in multiple categories.
    • Submit documentation where noted.
  3. Submit a $50 application fee to the AGS Membership Department (address below)

Only complete applications reaching the 20 point minimum will be forwarded to the Fellowship Review Panel for their review and recommendations. Final approval of all AGSF applicants will be considered by the AGS Board of Directors at its May and November Board Meetings (depending on application submission before the March 15th and September 15th deadlines).

Things to keep in mind when completing the online application:

  • Complete only the items that apply.
  • Do not list identical items in multiple categories.
  • Submit documentation where noted.
Name: Date:
Address:
 
City: State:      Zip:  
Phone: Fax:
Email:
Year Membership in Society began:

CERTIFICATION

1. Certifying Body:
(ABIM, ABFM, ABPN, AOBIM, ALBGP, Other?)

Certified in (list all): Initial Certification Date:  

(3 points for initial certifications, 3 points maximum)

 

2. Recertification   Dates
Recertification   Dates

(1 point for recertification, 1 point maximum)

 

3. For Physicians Only
Geriatrics Certificate of Added Qualifications or geriatrics board certification)

Date:

(1 point for CAQ, 1 point maximum)

AGS ACTIVITIES

4. List up to 5 AGS Annual Meetings that you have attended

1. Date   Location
2. Date   Location
3. Date   Location
4. Date   Location
5. Date   Location

(1 point for each, 3 points Min requirement, 5 points maximum)

5. List CE meetings sponsored by the AGS or AGS Affiliates that you have attended

Meeting Sponsor City/State Month/Year

(1 point for each, 3 points maximum)

6. List other AGS sponsored or AGS Affiliate sponsored CE activity that you participated in (such as webcast, online CE, journal CE, etc.)

Activity Date

(1 point for each, 3 points maximum)

7. List non-published research presented at an AGS sponsored or endorsed meeting

Topic Meeting Month/Year

(1 point for each, 3 points maximum)

8. List other AGS activities that you have participated in (Volunteer mentor, Spokesperson, Health in Aging Advocacy Center, etc.)

Activity Date

(1 point for each, 4 points maximum)

9. List any positions held for the AGS (Committee, Board, editorial panel, workgroup, etc.)

Position Committee/Board Years of Service

(1 point/year, 12 points maximum)

10. List any activities where you have served as the AGS representative to another group (e.g., guideline reviewer, member of a work group, etc.)

Activity Group Years of Service

(1 point for each activity, 8 points maximum)

PUBLICATIONS & RESEARCH

11. List grants related to aging research, education or clinical activity received

Title Grant Agency Month/Year Grant Amount

(1 point for each grant, 3 points maximum)

12. List authored Research or Clinical Review articles you have published in a peer-reviewed journal (such as the Journal of the American Geriatrics)

Title Journal Month/Year Published

(2 points for each article, 4 points maximum)

13. List articles that you have published in a non-peer reviewed medical publication

Title Journal Month/Year Published

(1 points for each article, 4 points maximum)

14. List if you have served as an author or on an editorial board for an AGS Publication, including print, online and patient education resources.

Publications Role Start/End Date

(2 points for each article, 4 points maximum)

15. List other aging related publications that you authored (e.g., book chapters, pamphlets, etc.)

Title Month/year Published

(1 point for each title, 3 points maximum)

TEACHING

16. List participation as a speaker or moderator at an AGS National Meeting

Meeting Lecture Title Year

(2 points for each lecture, 4 points maximum)

17. List participation as a speaker or moderator at an AGS Affiliate Meeting

Meeting Lecture Title Month/Year

(1 point for each lecture, 2 points maximum)

18. List any geriatrics related teaching awards that you have received

Award Organization Month/Year

(1 point for each award, 2 points maximum)

19. List any significant geriatrics curriculum that you have designed

Curriculum Title Academic Organization Month/Year

(1 point for each curriculum, 2 points maximum)

20. List any volunteer patient education activities related to care of older adults

Activity Location # of Hours Month/Year

(1 point for every 12 hours spent volunteering, 2 points maximum)

21. Describe if you have performed any public relations activity that explains Geriatrics to the public such as lectures to civic groups, public service announcements, interviews, radio or TV appearances.

Activity Group/Location # of Hours Month/Year

(1 point for every 12 hours, 2 points maximum)

22. List any volunteer medical services related to older adults you performed

Activity City/State # of Hours Month/Year

(1 point for every 12 hours, 2 points maximum)

23. Service on Hospital, Health Care Systems, Community or Insurance Boards relating to geriatric issues

Organization City/State # of Hours Month/Year

(1 point for every 12 hours, 2 points maximum)

24. List active participation in aging related quality initiatives

Initiative # of Hours Month/Year

(1 point for every 12 hours, 2 points maximum)

25. List if you have served as a chair, officer, committee member or delegate of another health professional organization that serves older adults such as AMDA, ACP, AAFP, ASCP, NCGP, etc. or the AGS state affiliate organization of one of these groups

Position Organization Month/Year

(1 point for each activity, 3 points maximum)
Membership Type:
 Nurse
 Pharmacist
 Physician
 Physician’s Assistant		  Recognized
 Social Worker
 Specialist
 Other



Submit completed application to:

Hoon Jason Park
Membership Coordinator
American Geriatrics Society
40 Fulton St., 18th Floor
New York, NY 10038

jpark@americangeriatrics.org
T: (212) 308-1414
F: (212) 832-8646

Download the Advancement to Fellowship Application

* - Individuals are still considered eligible with a six month or less membership lapse within those five years.