Society of Family Planning: Application for junior fellowship

Membership application: Junior 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 Junior Fellowship

Post-graduate training and/or graduate degree requirement
In order to be eligible for Junior Fellowship in the Society of Family Planning, applicants must be currently enrolled in or have completed a post-graduate training or graduate degree program.

I am currently enrolled in a post-graduate training or graduate degree program (residency, fellowship, graduate degree, etc). *

I have completed a post-graduate training or degree program. *

Please list the name of the program in which you are or were enrolled and the completion or anticipated completion date:

Program:	*
Completion date:	*

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

Name of Primary Sponsor: *

Name of Secondary Sponsor: *

Please note: If you have published at least three (3) original research articles relating to family planning in peer-reviewed journals, are the first author of at least two (2) of those articles, and have presented an abstract at an SFP Annual Meeting,* you might qualify for full Fellowship and should use the application for Fellowship instead. Please call SFP staff at (866) 584-6758 or email info@societyfp.org for more information.

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. Beginning in 2011, these meetings will be part of the new annual North American Forum on Family Planning, produced by SFP and Planned Parenthood Federation of America.