International Resident/Fellow Member Sponsorship Form

Applicants for Resident/Fellow membership outside of ACP Chapters must be sponsored by a current ACP Fellow or Master. If a Fellow or Master cannot be located in the area, the applicant may substitute their Program Director as one of the sponsors. For a list of ACP International Chapters, please visit www.acponline.org/chapters.

The sponsor must provide a brief description of the training program in which the applicant is enrolled. The applicant may provide this information to the sponsor if necessary. This description may be provided on this form or via a separate document or e-mail from the sponsor and should include the following information, if possible:

Applicant ACP ID

Applicant First Name

Middle Initial

Applicant Last Name

Date of Birth

Name of residency or fellowship program

City and country of the residency or fellowship program

Name and e-mail address of the residency or fellowship Program Director (if applicable)

Year when training program was established (if known)

Number of residents or fellows enrolled in the training program

Description of program setting, such as academic or community-based (if appropriate)

Number of years required to complete the program