ACLP Applc for Fellowship 2024

Be sure to read the current eligibility criteria for ACLP Fellowship before submitting your application (link opens in a new tab or window.)

Application deadline: EOB July 1

1. Your contact details *This question is required.

First name
Last name
Credentials (MD, etc.)
Email

2. Enter the six (6) consecutive years of full Academy membership you wish to use to establish your eligibility (enter as a year range, e.g., 2008-2014).

Note: Trainee Academy membership of any type does not contribute to satisfying this eligibility criterion, nor does the duration of your time out of training. It is predicated solely on six consecutive years as a full Academy Member and may not coincide from your date of graduation of fellowship. Do not base your calculation only on the joining date displayed on your membership profile, as this date is irrespective of membership type. If you are unsure you meet this criterion, please contact the executive office for a records review. *This question is required.

3. Which three or more ACLP Annual Meetings have you attended in the last five years? (For each, enter just the year.) *This question is required.

4. Are you currently board certified by ABPN? *This question is required.

Please enter an 'other' value for this selection.

Year when your current certification/recertification expires *This question is required.

Please comment on your equivalency *This question is required.

5. Have you completed a dual residency? *This question is required.

Please enter an 'other' value for this selection.

6. Do you plan to submit additional supporting materials? If yes, please email additional materials to fellowship@CLpsychiatry.org with the email subject "ACLP Fellowship Candidate Materials." Additional materials are due by the same deadline as your application. *This question is required.

7. Membership on an Academy committee, subcommittee, or taskforce.

8. Service as chair, co-chair, or vice-chair of an Academy special interest group (SIG).

9. Presented at an Academy annual meeting as (A) a moderator, speaker, or discussant for a preconference course or general session; or (B) a lead presenting author for a poster or oral paper session.

10. Please upload your CV (MS-Word or PDF file formats only; max file size 1MB; please include your name in the filename of your CV) *This question is required.

File: {{filename}} delete

11. Please upload a portrait photo. Photos are not used in judging and only the photo of the award winner is used for annual meeting program presentation purposes. Accepted file formats: png, gif, jpg, jpeg; max file size 1MB *This question is required.

File: {{filename}} delete

12. Please provide the phonetic spelling of your name

13. Pledge of Fellowship

I hereby pledge to the Academy of Consultation-Liaison Psychiatry that I shall:

Continue to foster Academy objectives for advancing scientific knowledge concerning mind, body, and environment;
Promote interrelationships through research, education, and practice; and
Encourage cooperation with other fellow scientists in related disciplines.

Enter your name in the box to affirm your commitment to this Pledge. *This question is required.

There are no further questions. Click Submit to file this application. Thank you.