AAPA Caucus Application

AAPA CAUCUS APPLICATION FORM

HA-2200.5.1
A caucus is defined as a group of five or more AAPA members who share a common concern, interest, or goal in the delivery of and access to health care. Caucuses are national or international in scope and complement the vision or core values of AAPA. Caucuses seek recognition by and continue to be officially recognized by the HOD. They are independent of AAPA and they are not chartered. Caucuses may also serve as resources and as advisors to AAPA.
[Adopted 2000, amended 2005, reaffirmed 2010]

HA-2200.5.2
The Constituent Relations Work Group shall review the completed application and will present a resolution to the House of Delegates.

To be considered for recognition, the caucus shall:
1. Submit the appropriate AAPA application to the Constituent Relations Work Group.
2. Have a minimum of 5 AAPA fellow members.
3. Submit the bylaws of the organization for review by Constituent Relations Work Group.
[Adopted 2002, amended 2007 and 2008]

HA-2200.5.3
All members of an officially recognized caucus are encouraged to be members of the AAPA.
[Adopted 1997, reaffirmed 2005, amended 2000 and 2010]

HA-2200.5.4
A caucus may amend its bylaws to create alternative membership categories that may include members who elect not to join AAPA or are ineligible for AAPA membership. Caucus members who are not AAPA members may be active in caucus affairs but may not participate in issues relating to AAPA, such as voting for AAPA delegates, submitting resolutions, or representing the caucus in the AAPA governance structure.
[Adopted 1997, reaffirmed 2002 and 2007]

HA-2200.5.5
All officers of an officially recognized caucus must be and remain fellow members in good standing of AAPA for the duration of their term in office. Any caucus that is unable to fill all of its officer positions with AAPA fellow members may petition the Constituent Relations Work Group for consideration of exemption from this policy.

Organization Information:

Name of caucus:

Date caucus was founded:

Please attach a copy of bylaws and organizational documents or fax to 703-684-1924 attention CO Administrator.

If your organization has been incorporated, please attach a copy of your articles of incorporation and state chartering acknowledgement or fax to 703-684-1924 attention CO Administrator.

Does the caucus have elected officers?

Yes No

Please list caucus officer's information (including name, address, title in organization and term in office).

Are fellow members required to be AAPA members?

Yes No

How many members does the caucus have?

Goals and Purposes:

Please state the goals and purposes of the caucus.

Please list the activities the caucus has engaged in since organizing.

Please list the activities the caucus has planned for the future.

Please state why the caucus is applying for official recognition.

Contact Information:

Contact Name:

Position in Organization:

Street Address:

City:

State:

Zip Code:

Phone Number:

E-mail:

Agreement:

This caucus understands that to maintain continued recognition with all privileges, the actions of the caucus must not conflict with the 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.

AAPAs 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 caucus status, contact CO Administrator, by phone at 703-836-2272 ext. 3200 or by email at coadministrator@aapa.org.