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Membership application: Full Fellow

* required fields

Contact information

First name: *
Last name: *
Middle name:  
Degrees: *
Current institution: *
Department: *
Title: *
Telephone: *
E-mail: *
Alternative Email:  

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. If you do not want a hard copy please check the “online only” check box below):

Address 1: *
Address 2:
City: *
State: *
Region: *
Country: *
Zip: *  
Online only Contraception journal


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:
 
Check here if you are currently enrolled in or completed a Fellowship in Family Planning.
 
Highest Degree:  
 
Do you currently, or are you in training to, provide clinical care?
 
Do you currently, or are you in training to, conduct research?



Criteria for Fellowship


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: *


Presentation requirement

In order to be eligible for Fellowship in the Society of Family Planning, applicants must have either 1) been listed as an author on at least one scientific abstract presented (oral or poster presentation) at an SFP Scientific Meeting; or 2) have authored 15 publications in family planning, to be submitted to the Membership Committee and the SFP board for review as to whether the scholarly work supports induction of the fellow.*

In what year were you listed as an author on a scientific abstract presented at an SFP Annual Meeting (Reproductive Health 2010 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 either 1) published at least three original research articles relating to family planning in peer-reviewed journals and have been listed as the first author on at least two of these; or 2) have been first author on a minimum of two articles and one academic book chapter.

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 (or book chapter, as first author): *


Background information


Please list your current research interests:

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


(mark all that apply)

       
   

Other (please specify)


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

     
   
     

Other (please specify)

Countries you work in:


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

   
 

Other (please specify)


How did you hear about the Society of Family Planning?


*Demographics


Which category best describes your gender identity?*


Are you of Hispanic, Latino, or Spanish origin? *


Which category best describes your race?*

* Will not be visible to the public


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:
*



*From 2005 through 2010, SFP Scientific Meetings were held annually at the Reproductive Health conference. However, as of 2011, SFP’s annual scientific meeting is held in conjunction with the annual North American Forum on Family Planning, produced by SFP and Planned Parenthood Federation of America.