Ohio-ACC Fellow in Training Council Application

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Email *

Represent your training institution as a member of the Ohio-ACC Fellow in Training Council. Share your ideas, network with colleagues, and get involved with the Ohio-ACC. Applications are now being accepted. The deadline is April 15.

Expectations: Serve as the liaison between your fellowship program and the Ohio-ACC FIT Council, be responsive to communications, disseminate information from the council to your fellowship program colleagues. To the best of your ability: attendance at the Ohio-ACC Annual Meeting on 10/19/24, at the Ohio-ACC Spring Summit (April 2025) in Cleveland, and at the Ohio-ACC Legislative Day in Columbus (May 2025).

First Name *

Last Name *

Designation *

(DO, MD, MBBS)

Street Address *

City, State, Zip *

Work Phone *

Mobile Phone *

Twitter handle (e.g. @ohioacc)

Training Program Name *

Fellowship Year as of July *

(1st, 2nd, etc.)

PAST SERVICE *

I have served on the Ohio-ACC Fellow in Training Council in the past.

Yes

I AM APPLYING FOR: *

Check all that apply

Ohio-ACC FIT Council Member

Ohio-ACC FIT Council Chair

Required

Please provide a one-paragraph statement describing why you would like to be the Ohio-ACC fellow in training council representative from your training program and/or Council Chair: *

Letter of Support *

Please provide a letter of support from your Program Director or an Ohio-ACC Board of Trustees Member (http://www.ohioacc.org/board-of-trustees/). The letter should be sent to ohioacc@gmail.com by April 15th.

I will provide the letter by April 15th.

Agreement *

I agree to be considered for the Ohio-ACC FIT Council. I understand that the term is one year (July of this year - June of next year) with the option of one renewable year. I understand that all candidates must go through the formal nomination process for the second term. I have read and agree to the terms stated:

I agree.

Electronic Signature *

Send me a copy of my responses.

Submit

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