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ASSOCIATION OF PROFESSORS OF GYNECOLOGY AND OBSTETRICS
Application: 2022-2023 Academic Scholars and Leaders Program
Applications for the Class of 2022-2023 are being accepted now.
Name
*
First
Last
Suffix
I've Been an APGO Member Since
*
Institution
*
Business Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Fax
Email
*
My Local Mentor Will Be
*
Mentor Email
*
Major Educational Responsibilities
*
Upload Supporting Documents
*
Max. file size: 50 MB.
Please submit one .pdf containing all application documents: Current curriculum vitae Statement of Department Chair Commitment and Support (download form from APGO Web site). A separate cover letter from your chair stating what he/she expects the value of your participation will be to the university/or institution. A personal statement (limited to two pages, double-spaced) including 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. If you have applied before, a statement of what you have accomplished since your last application.
Board Certification Status
Board Certified
Board Certification Scheduled for 2022
Not Board Certified
Clerkship School 101 & 201 Attended
2019
2020
2021 (or will attend)
Clerkship 301 Attended
2019
2020
2021 (or will attend)
APGO Faculty Development Seminar 2019
Attended
Presented
APGO Faculty Development Seminar 2020
Attended
Presented
APGO Faculty Development Seminar 2021
Attended
Presented
CREOG & APGO Annual Meeting 2019
Attended
Presented
CREOG & APGO Annual Meeting 2020
Attended
Presented
CREOG & APGO Annual Meeting 2021
Attended/Will Attend
Presented/Will Present
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