AAPA Special Interest Group Identification Application

Special Interest Groups are defined as a group of AAPA members who share a common concern, interest, or goal and desire to meet informally. The purpose of a special interest group shall be consistent with the vision and mission of AAPA.

The Constituent Relations Committee has the responsibility for approving a SIG.

To be considered for approval, the SIG shall:

Submit the appropriate application to the Constituent Relation Committee (CRC)
Have a minimum of five members
Have at least one AAPA fellow member

[Adopted 1981, amended 1982, reaffirmed 1990, reaffirmed 1995, amended 1996, 2000, 2002, and 2007]

The AAPA does not require that special interest groups have a formal structure. The following information is collected by AAPA for identification purpose.

Prior to filling out this application please contact Sue Curtis, AAPA COS at 703/836-2272 ext 3318 or scurtis@aapa.org.

ORGANIZATION INFORMATION

Name of Special Interest Group

Date organization was founded

Does the special interest group have bylaws or organizational documents?

Yes

Does the special interest group have elected officers?

Yes

Please list a minimum of five of your fellow members or officers information
(Include names, state, and titles)

Are your fellow members required to be AAPA members?

Yes

How many members do you have?

GOALS AND PURPOSES

Please state the goals and purposes of the special interest group.

ACTIVITIES

Please list the activities the special interest group has engaged in since organizing.

FUTURE ACTIVITIES

Please list the activities the special interest group has planned for the future.

Is your special interest group planning to apply for AAPA recognition as a caucus or specialty organization?

In 0-1 years

In 1-3 years

In 3-5 years

Do not know

CONTACT INFORMATION

Contact Name

Position in organization

Address

Contact phone numbers for organization

E-mail address

AGREEMENT

This special interest group understands that to maintain continued recognition with all privileges, the special interest group’s actions must not conflict with AAPA’s vision or mission.

Name of person agreeing to comply with AAPA mission and vision and date of agreement

AAPA’s vision is that PAs will be worldwide leaders vital to providing and improving medical care of all people.
AAPA’s mission is to promote quality, cost-effective, and accessible health care and to promote the professional and personal development of physician assistants.
For more information regarding special interest group status, contact Constituent Organization Services, 703/836-2272; scurtis@aapa.org.