Application for Fellowship Checklist
PLEASE READ BEFORE COMPLETING APPLICATION
I am certified in my specialty by an American Surgical Specialty Board which is a member of the American Board of Medical Specialties, or an American Osteopathic Surgical Specialty Board, or an appropriate specialty certification by the Royal College of Physicians and Surgeons of Canada.
I have practiced surgery for at least one year after the completion of all formal training.
I hold a full and unrestricted license to practice medicine and surgery in the state or province where I practice and know of no adverse actions that would affect the status of my licensure.
I hold a current appointment on the surgical staff of a hospital with no reportable action pending that could adversely affect staff privileges at any hospital.
I practice as a general surgeon or as a surgical specialist within the scope of my specialty.
Surgical Case List
You must be able to provide the College with a surgical case list reflecting the type and volume of surgical cases you have performed during the past year. Please do not submit this list until requested to do so.
Applicants who are not Associate Fellows are required to pay an application fee of $200.00 (US). This fee must be submitted with the application and is not refundable. Applications will not be processed until the application fee has been received.
Additional information can be found in the Fellowship Requirements.
Need assistance with your application? Contact firstname.lastname@example.org or call 1-800-293-9623.