international fellowship
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AMERICAN HEART ASSOCIATIONCOUNCIL ON CLINICAL CARDIOLOGY
CRITERIA FOR FELLOWSHIP/INTERNATIONAL FELLOWSHIP& INSTRUCTIONS FOR COMPLETING FELLOWSHIP APPLICATIONS
DESCRIPTION AND TYPES OF FELLOWSHIP
A. FELLOWSHIPThe Leadership Committee of the Council on Clinical Cardiology of the American Heart Association establishes the criteria for Fellowship and elects Fellows to the Council. Fellowship in the Council recognizes excellence, innovation and leadership in clinical cardiology in the private practice or academic setting. Fellowship is generally reserved for physicians and medical scientists who are board certified in cardiovascular disease . Council members are eligible for Fellowship and must be able to demonstrate ongoing involvement in activities that reflect significant and current service to the American Heart Association. Board certification and competence in clinical practice are necessary for election to Fellowship.
In exceptional circumstances, at the discretion of the Leadership Committee of the Council on Clinical Cardiology, Fellowship may be granted to an individual who does not have subspecialty boards in cardiovascular disease. Candidates without subspecialty board certification must have equivalent credentials which are adequately documented in letters by the Proposer and Seconder. Credentials equivalent to U.S. or Canadian subspecialty board certification may include overseas credentialing if comparable, academic credentials, and acknowledged stature as a consultant in cardiovascular disease.
AHA MISSION STATEMENT :
The American Heart Association is a national voluntary health agency whose mission is to reduce disability and death from cardiovascular diseases and stroke. Examples reflecting service to the American Heart Association are outlined below .
CRITERIA FOR FELLOWSHIP:The candidate for Fellowship must be:
A physician or medical scientist who is a citizen or permanent resident of the United States or Canada. Board certified in cardiovascular disease (see above). Recognized by her/his peers as a competent physician consultant in cardiovascular disease who holds
herself/himself to the highest ethical standards of professional behavior. Able to demonstrate significant and current service to the American Heart Association Active member of the Council on Clinical Cardiology.
The candidate should outline her/his involvement in one or more of the following activities that reflect significant and current service to the American Heart Association. Examples include, but are not limited to:
1) Active participation on committees or boards at the AHA division, affiliate, national or council level.
2) Participation and /or leadership in the areas of:a) Development/fundraising – e.g. heart walks, galas, etc.b) Advocacy – e.g. lobbying efforts at local/ national levelc) Programs – professional and/or lay education; AHA writing groups; program or abstract
grading committees at AHA Scientific Sessions or AHA conferences; speakers bureau; Operation Heartbeat; Operation Stroke; Get with the Guidelines; etc.
d) Research peer review – e.g. grant review at local/national level; journal review for AHA scientific journals.
Letters of Recommendation must cite specific activities and accomplishments that relate to the criteria outlined above.
Revised 07-01-2003
The following privileges are conferred upon Fellows of the Council:
Upon receipt of certification, designated as Fellow of the American Heart Association (F.A.H.A.) Receipt of Council Newsletter Reduced admission to the American Heart Association’s Scientific Sessions Reduced fee to postgraduate courses sponsored or co-sponsored by the Council Eligibility to serve on Council committees upon the recommendation of a committee chairman and
approval by the Council chairman Summary notes of the Council’s Annual Business Meeting (upon request) Receipt of a Fellowship certificate Reduced subscription rate to all AHA journals. A complete roster of the Fellows of the Council (upon request)
B. INTERNATIONAL FELLOWSHIP
Candidates for International Fellowship must be physicians or non-physician medical scientists who reside permanently outside of the United States or Canada. The candidate must be of good character, ethical in his or her practice, and have good standing in the community. Candidate must be continually active in the practice of cardiology or in scientific or educational work bearing directly on cardiology.
All candidates must be considered on the basis of the following qualifications: outstanding service reflecting the goals and mission of AHA , and should be considered equivalent to those as outlined ; outstanding scholastic or academic achievement; national and international recognition as a cardiologist or cardiovascular scientist; outstanding service to the appropriate cardiovascular societies or organizations of his or her country of residence; publications, lectureships, visiting professorships, and other documents in support of the candidate’s contributions.
Except under unusual circumstances, candidates should be certified by the appropriate cardiovascular certification organization of the country in which they received their cardiovascular training or by the similar organization in their country of residence if such an organization exists.
International Fellows shall receive all of the privileges of Fellowship.
C. HONORARY FELLOWSHIP
The Leadership Committee may, under special circumstances, designate a limited number of outstanding physicians or scientists in the field of cardiology as Honorary Fellows.
D. EMERITUS FELLOWSHIP
Emeritus status may be granted upon request, in writing, after a Fellow has reached the age of 65. Emeritus Fellows shall have all of the rights and privileges of Fellows, but are not required to pay dues.
Revised 07-01-2003
REVIEW BY THE MEMBERSHIP/CREDENTIALS COMMITTEE
Based upon the information submitted in the Fellowship application, the Membership and Communications Committee will recommend whether:
1. A candidate should be ELECTED to Fellowship or International Fellowship;2. The proposal should be DEFERRED;
3. The proposal should be DECLINED.
THESE RECOMMENDATIONS ARE BASED UPON CRITERIA APPROVED BY THE LEADERSHIP COMMITTEE OF THE COUNCIL ON CLINICAL CARDIOLOGY.
COMPLETING THE FELLOWSHIP APPLICATION
A. CANDIDATE
1. Type all information and answer all applicable questions. Handwritten applications and/or applications which are not completed correctly will be returned to the candidate (i.e., candidate states “Please see attached CV” for any of the questions or fails to include curriculum vitae or supporting documents).
2. If space provided is inadequate for completing any portion of the application, attach the additional information to the back of the application.
3. Sign the application.
4. Include a copy of candidate’s curriculum vitae, including bibliography.
5. Send the completed application including Criteria and Instructions to the Proposer and provide him/her with the name and address of the Seconder. (After approving the application and attaching a letter of support, the Proposer will forward the application to the Seconder for his/her approval and letter of support.)
B. PROPOSER AND SECONDER
1. Must be Fellows of the Council on Clinical Cardiology.
2. Must review and ensure completeness of application, denote approval with his/her signature, and attach letter of support. [See note below]
PROPOSER AND SECONDER PLEASE NOTE:
As you prepare your letter supporting a person interested in applying for Fellowship in the Council on Clinical Cardiology, you are encouraged to carefully read the Criteria for Fellowship/International Fellowship and Instructions for Completing Fellowship Applications. The Council is especially interested in ensuring that individuals applying for Fellowship can demonstrate involvement in activities that further the mission of the AHA. The instruction sheet is quite explicit on this matter. It would be helpful, especially in instances where the candidate is not in full-time academics, to specify what their “involvement in clinical and/or academic activities that reflect the mission of the American Heart Association” and “public service in the area of cardiovascular disease” are. If you have further questions, do not hesitate to contact the Credentials Secretary.
3. Proposer should send application to Seconder. Seconder should mail the completed and approved application and supporting documents to: Credentials Secretary, Scientific Councils, American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231-4596. The Credentials Secretary can be reached at (214) 706-1587 or FAX (214) 373-3406.
Revised 07-01-2003
AMERICAN HEART ASSOCIATIONCOUNCIL ON CLINICAL CARDIOLOGY
APPLICATION FOR FELLOWSHIP OR INTERNATIONAL FELLOWSHIP
The Council on Clinical Cardiology of the American Heart Association promotes excellence in patient care, education and clinical research in cardiovascular disease.
APPLICATIONS MUST BE SUBMITTED BY JANUARY 15 OR JUNE 1
PLEASE TYPE ALL INFORMATION.COMPLETED FORM MUST BE ACCOMPANIED BY CURRICULUM VITAE AND
LETTERS OF RECOMMENDATION FROM PROPOSER AND SECONDER.
We, the undersigned, propose the person named below for Fellowship in the Council on Clinical Cardiology, and herewith submit information concerning his/her qualifications for consideration by the Membership and Communications Committee for: ( ) FELLOWSHIP ( ) INTERNATIONAL FELLOWSHIP
(1) Full Name of Candidate with Degree(s) - as it should appear on the Fellowship certificate:
______________________________________________________________________________
(2) Office Address:
______________________________________________________________________________
______________________________________________________________________________
Telephone Number________________________ Fax Number_____________________________
Email_________________________ Membership Number (required): _____________________
(3) Place of Birth_____________________________ Date of Birth____________________________
(4) Citizen of_______________________________________________________________________
( ) U.S. Born ( ) U.S. Naturalized - When?_______________________ ( ) N/A
( ) U.S. Visa Type______________________ Date_______________ ( ) N/A
(5) Intend to obtain U.S. citizenship? ( ) Yes ( ) No ( ) N/A
Intend to remain in U.S.? ( ) Yes ( ) No ( ) N/A
(6) Education: Institution/Location Graduation Date Degree
College _________________________________________________________________
_________________________________________________________________
Medical _________________________________________________________________
_________________________________________________________________
Revised 07-01-2003
(7) Internship - Institution/Location:
______________________________________________________________________________
Inclusive dates__________________________________________________________________
(8) Graduate Education - Residencies, Fellowships or other formal graduate work:
Institution/Location Field of Study Inclusive Dates
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(9) Licensed to practice in what State(s)_________________________________________________
(10) Practice limited to Internal Medicine and/or Cardiology since______________________________
(11) U.S. ONLY - If certified by the American Board of Internal Medicine, show certification date and
number________________________________________________________________________
(12) U.S. ONLY - If certified by the Subspecialty Board in Cardiovascular Disease, show certification date
and number_____________________________________________________________________
(13) Is the candidate currently in private practice? ( ) Yes ( ) No
If yes, where?___________________________________________________________________
(14) Is the candidate engaged in teaching? ( ) Yes ( ) No
If yes, explain:___________________________________________________________________
(15) Is the candidate engaged in research? ( ) Yes ( ) No
If yes, explain:___________________________________________________________________
(16) Is the candidate engaged in full-time academic medicine? ( ) Yes ( ) No
(17) List public service in the area of cardiovascular disease (e.g., public lectures, participation in public education, local AHA affiliate/division involvement (U.S. ONLY), etc.) (required):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Revised 07-01-2003
18) Special qualifications or other relevant information not previously mentioned:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
THE MEMBERSHIP/CREDENTIALS COMMITTEE REQUESTS THAT EACH OF THE FELLOWS SIGNING THIS APPLICATION EXPLICITLY FOLLOW THE DIRECTIONS ACCOMPANYING THIS FORM.
IF THE CRITERIA AND INSTRUCTIONS ARE MISSING, PLEASE CONTACT THE CREDENTIALS SECRETARY.
(20) Proposer ___________________________________________________________Signature Date
___________________________________________________________Address
___________________________________________________________Address
___________________________________________________________Phone Number Fax Number
____________________________Email Please remember to attach a letter of support
(21) Seconder ___________________________________________________________Signature Date
___________________________________________________________Address
___________________________________________________________Address
___________________________________________________________Phone Number Fax Number
____________________________Email
Please remember to attach a letter of support
(22) Candidate ___________________________________________________________Signature Date
Month and Year of Birth ________/_________ Gender: M FRace/Ethnicity:_ % of time spent (=100%):African American ___ AdministrativeAlaskan Native ____ Patient CareAmerican Indian ___ ResearchAsian or Pacific Islander_ ___ TeachingHispanic ___ Other (specify)____________________ White
Revised 07-01-2003
JOURNAL SELECTION FORM
Fellows of the Council on Clinical Cardiology are required to maintain their membership at the Premium Professional Level $150.00/year and must subscribe to one of the two journals, Circulation or Circulation Research.
Please indicate on this form which of the two journals you would like to receive and return the form to us with your fellowship proposal.
By notifying us in advance of your journal preference, your subscription and membership records can be coordinated.
Upon election to fellowship you will be billed:
U.S. DUES
$356.00 includes subscription to Circulation $379.00 includes subscription to Circulation Research
NON-U.S. DUES
$503.00 includes subscription price to Circulation $433.00 includes subscription to Circulation Research
Please check one: [ ] Circulation [ ] Circulation Research
BILL TO:
Name: _________________________________________________________________
Address: _________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
If you are a current subscriber, please state your account number:
#____________________________________________________
Subscription Rates Effective through December 2003
Revised 07-01-2003