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REGISTER
MEMBERSHIP
ABOUT US
PROGRAMS
EVENTS
RESOURCES
RESEARCH
AWARDS
JOB BOARD
NEWS
CONTACT
Membership
Options & Fees
Criteria
Benefits
Application
Membership Application
Which membership would you like to apply for?
Please select one:
Active Program Membership
Provisional Program Membership
Individual Membership
INDIVIDUAL MEMBERSHIP APPLICATION
CONTACT INFORMATION
ACTIVE MEMBERSHIP APPLICATION
CONTACT INFORMATION
PROGRAM INFORMATION
Sponsoring Institution and Affiliates for Postgraduate Program*
Point of Contact for Postgraduate Program*
Official Program Name*
Program Duration*
Application Deadline*
Interview Dates*
Start Date*
Class Size*
Year of First Graduate (or year of first expected graduate)*
Program Director (include credentials)*
Medical Director (include credentials)*
Faculty and Instructional Staff (list all with credentials)*
Clerical and Support Staff (list all with credentials)*
Professional Development Offered to Administrative Personnel*
Financial Resources to Support Postgraduate Program*
Facilities for Instruction (i.e. classroom, simulation lab, sleep rooms, clinical practice sites)*
Clinical Support Services (i.e. on-site pharmacy, laboratory, and radiology)*
Equipment, Supplies, and Workspace Provided to PA Resident/Fellow*
Learning Resources Available to PA Resident/Fellow Used Throughout Postgraduate Program*
Admission Policies and Procedures*
Evaluation Measures of PA Resident/Fellow Used Throughout Postgraduate Program*
Methods Used to Evaluate Postgraduate Program Effectiveness*
Healthcare Benefit*
Malpractice Benefit*
Vacation/Sick Time Provided*
CME Benefit*
Other Benefits Not Listed Above*
Postgraduate Program Website*
Methods of Recruitment*
Academic Certificate Awarded Upon Completion*
Disciplinary and Grievance Policies*
Method of Keeping Records of PA Resident/Fellow and Graduation*
Describe Postgraduate Program Curriculum (i.e. specific rotations, methods of instruction, learning objectives for didactic and clinical education components*
Upload supporting documents
PROVISIONAL MEMBERSHIP APPLICATION
CONTACT INFORMATION
PROGRAM INFORMATION
Sponsoring Institution and Affiliates for Postgraduate Program*
Official Program Name*
Point of Contact for Postgraduate Program*
Program Duration*
Application Deadline*
Interview Dates*
Start Date*
Class Size*
Year of First Graduate (or year of first expected graduate)*
Program Director (include credentials)*
Medical Director (include credentials)*
Faculty and Instructional Staff (list all with credentials)*
Clerical and Support Staff (list all with credentials)*
Professional Development Offered to Administrative Personnel*
Financial Resources to Support Postgraduate Program*
Facilities for Instruction (i.e. classroom, simulation lab, sleep rooms, clinical practice sites)*
Clinical Support Services (i.e. on-site pharmacy, laboratory, and radiology)*
Equipment, Supplies, and Workspace Provided to PA Resident/Fellow*
Learning Resources Available to PA Resident/Fellow Used Throughout Postgraduate Program*
Admission Policies and Procedures*
Evaluation Measures of PA Resident/Fellow Used Throughout Postgraduate Program*
Methods Used to Evaluate Postgraduate Program Effectiveness*
Healthcare Benefit*
Malpractice Benefit*
Vacation/Sick Time Provided*
CME Benefit*
Stipend Amount*
Other Benefits Not Listed Above*
Postgraduate Program Website*
Methods of Recruitment*
Academic Certificate Awarded Upon Completion*
Disciplinary and Grievance Policies*
Method of Keeping Records of PA Resident/Fellow and Graduation*
Describe Postgraduate Program Curriculum (i.e. specific rotations, methods of instruction, learning objectives for didactic and clinical education components*
Upload supporting documents
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