Society of Family Planning: Application for fellowship

Membership application: Fellow

* required fields

Contact information

Name:	*
Degrees:	*
Current institution:	*
Department:	*
Professional title:	*
Telephone:	*
E-mail:	*

Mailing address (Please list the address where you would prefer to receive your copy of SFP's official journal, Contraception, should you be selected for membership.):
Address:	*

City:	*
State:	*
Zip:	*

Education (Please fill out all fields that apply.)

Undergraduate		Institution:
		Location:
		Dates:
		Degree:

Graduate 1 not applicable		Institution:
		Location:
		Dates:
		Degree:

Graduate 2 not applicable		Institution:
		Location:
		Dates:
		Degree:

Medical school not applicable		Institution:
		Location:
		Dates:
		Degree:

Residency 1 not applicable		Institution:
		Location:
		Dates:

Residency 2 not applicable		Institution:
		Location:
		Dates:
(if more than 2 residency locations, please use an additional page)

Fellowship not applicable		Institution:
		Location:
		Dates:

Criteria for Fellowship

Sponsor requirement
Applicants must be sponsored by two SFP Fellows in good standing. Junior Fellows and Candidate Fellows may not serve as sponsors. SFP staff will verify sponsors before processing applications.

Name of Primary Sponsor: *

Name of Secondary Sponsor: *

Presentation requirement
In order to be eligible for Fellowship in the Society of Family Planning, applicants must have been listed as an author on at least one scientific abstract presented (oral or poster presentation) at an SFP Scientific Meeting.* (If you do not meet the presentation requirement, but do meet the rest of the membership criteria, we encourage you to apply as a Candidate Fellow.)

In what year were you listed as an author on a scientific abstract presented at an SFP Annual Meeting (Reproductive Health 2005 or later)? *

Title of abstract (poster or oral presentation): *

Research/publication requirement
In order to be eligible for Fellowship in the Society of Family Planning, applicants must have published at least three (3) original research articles relating to family planning in peer-reviewed journals. The applicant must be listed as the first author on at least two (2) of these publications.

Please list your selected articles below using Medline format:

Article #1 (you must be first author on this article): *

Article #2 (you must be first author on this article): *

Article #3: *

Background information

Please list your current research interests:

Primary:			Secondary:
1.			3.
2.			4.

What types of studies interest you? (mark all that apply)

	Qualitative			Clinical trials			Basic science
	Survey studies			Meta analysis			Decision analysis

Other (please specify)

What is your primary field of professional expertise or academic focus?

	Family medicine			Nursing			Social science
	Midwifery			Obstetrics & gynecology			Osteopathic medicine

Other (please specify)

What are the primary reasons you would like to become a member of the SFP?

	Professional development			Networking/community
	Research funding opportunities			Educational opportunities
	Encouraged by Fellowship Program

Other (please specify)

How did you hear about the Society of Family Planning?

Do you have a colleague who you feel should be encouraged to apply for membership in the Society of Family Planning? If so, please provide:

Name:
Institution:
Email address:

Please attach your current curriculum vitae: *

*Since our inception in 2005, SFP Scientific Meetings have been held annually at the Reproductive Health conference.