AAPA Special Interest Group Identification Application

AAPA SPECIAL INTEREST GROUP IDENTIFICATION APPLICATION

HA-2200.6.1
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 (SIG) shall be consistent with the vision and mission of AAPA.

The appropriate work group has the responsibility for approving and suspending SIG status.
[Adopted 1981, reaffirmed 1990 and 1995, amended 1982, 1996, 2000, 2002, 2007, and 2009]

The Constituent Relations Committee has the responsibility for approving a SIG. To be considered for approval, the SIG shall:

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

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

For more information regarding special interest group status, contact CO Administrator, by phone at 703-836-2272 ext. 3200 or by email at coadministrator@aapa.org.

Organization Information:

Name of special interest group:

Date special interest group was founded:

Does the special interest group have bylaws or organizational documents?

Yes

No

Does the special interest group have elected officers?

Yes

No

Please list a minimum of five fellow member's or officer's information (including name, address and title in organization):

Are fellow members required to be AAPA members?

Yes

No

How many members do you have?

Goals and Purposes:

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

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

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?

Yes, in 0-1 years

Yes, in 1-3 years

Yes, in 3-5 years

Do not know

Contact Information:

First Name:

Last Name:

Position in Organization:

Street Address:

City:

State:

Zip Code:

Phone Number:

E-mail:

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.

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.

Name of person agreeing to comply with AAPA mission and vision:

Date:

For more information regarding special interest group status, contact CO Administrator, by phone at 703-836-2272 ext. 3200 or by email at coadministrator@aapa.org.