APGO Academic Scholars and Leaders Class of 2026-2027 Application

Please have the following prepared to upload with your application. 1. Current curriculum vitae 2. Statement of Department Chair Commitment and Support Download form 3. A separate cover letter from your chair stating what they expect the value of your participation will be to the university/or institution 4. A personal statement (limited to two pages) indicating why you want to participate in this course, a statement of agreement to complete course requirements, and how you intend to use the knowledge and skills gained from this experience 5. If you have applied before, a statement of what you have accomplished since your last application

Name*

First Last Suffix/Degrees

I've Been an APGO Member Since*

Institution*

Academic Rank:*

Instructor, Assistant Professor, Associate Professor, Professor, Etc.

Business Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

My Local Mentor Will Be*

Mentor Email*

Board Certification Status*

Board Certified
Board Certification Scheduled for 2026
Not Board Certified

Which of the following roles do you currently hold at your institution?*

Other

Please describe any of the above:

In what ways have you developed curricula and/or generated education research?*

Curricular development and implementation at my institution
Education research that has led to at least one manuscript in a peer-reviewed journal
Education research that I presented as at least one abstract at a meeting
PI or co-PI of a funded educational project grant
Dissemination of curricula I developed beyond my institution (please describe below)

Please describe or add other:

In what ways have you done clinical research?

Publication of at least one clinical, basic, or translational science research article in peer-reviewed journals*

Yes
No

PI or co-PI of a funded clinical, basic, or translational science research grant*

Yes
No

Other:

In what ways has your teaching been honored?*

No teaching award yet
At least one teaching award as a resident
At least one teaching award as a faculty member
The APGO Excellence in Teaching Award, given at my institution
The CREOG Faculty Teaching Award, given at my institution
The APGO William N. P. Herbert, MD Promising Educator Award given by APGO on a national level
At least one teaching award on a national or regional level (not including the APGO and CREOG awards listed above).

Other teaching awards:

Which APGO meetings have you attended at least once in the last five years?*

Martin L. Stone, MD, Faculty Development Seminar
Susan M. Cox, MD, Clerkship Directors’ School
CREOG & APGO Annual Meeting

Upload your CV and supporting documents here:*

Drop files here or

Max. file size: 50 MB.

Upload your CV here and supporting documents here. All documents are required.

Additional file upload, if needed

Max. file size: 50 MB.

We are asking the following questions to understand the diversity of our APGO ASL community, not to use for selection purposes. Answering the questions is optional.

What is your racial identity?

Black/African American
Asian/Asian American
White/Caucasian
Native American/American Indian
Pacific Islander
Multiracial
Prefer not to answer

Other, please describe:

Are you of Hispanic ethnicity?

Yes
No
Prefer not to answer

What is your gender?

Cis-female
Trans-female
Cis-male
Trans-male
Non-binary
Prefer not to answer

Other, please describe:

Are you the first in your family to go to college?

Yes
No
Prefer not to answer

What is your subspecialty?

General ob-gyn
Maternal Fetal Medicine
Reproductive Endocrinology & Infertility
Gynecologic Oncology
Complex Family Planning
Minimally Invasive Gynecologic Surgery
Female Pelvic and Reconstructive Medicine
Adolescent Gynecology
Reproductive Infectious Disease

Other, please describe:

What advanced degrees, in addition to your medical degree, do you hold?

Master's Degree (please describe below)
PhD (please describe below)
None

Describe degrees above or add other(s):

In addition to the ASL program, are you considering future advanced training?

No
Yes (please describe)

If yes, please describe:

Have you pursued advanced training in education in the past?

No
Yes (please describe)

If yes, please describe:

ASSOCIATION OF PROFESSORS OF GYNECOLOGY AND OBSTETRICS

APGO Academic Scholars and Leaders Class of 2026-2027 Application

Application: 2026 - 2027 Academic Scholars and Leaders Program

In what ways have you done clinical research?