ACP Affinity Group Application Form

An ACP Affinity Group (AG) is a forum of ACP members with shared personal and professional interests. At least four active ACP members may form a steering committee and submit an application to the Membership Committee for review and approval. Once established, the Affinity Group is open to any member in good-standing who wishes to participate.

Please provide information on at least four current members of the steering committee

Member #1

Name:

Member ID:

Member Email:

Member #2

Name:

Member ID:

Member Email:

Member #3

Name:

Member Email:

Member #4

Name:

Member Email:

Which steering committee member will be the primary liaison with ACP?

List the proposed goals for the group

PLEASE NOTE: When developing goals, keep in mind that Affinity Groups may advocate for the development of ACP policy but they do not have the authority to develop/create policy. ACP reserves the right to make modifications to ensure proposed goals align with this direction.

Goal #1:

Goal #2:

Define the constituency your Affinity Group will best represent

Which of the following ACP strategic themes does the Affinity Group best align (more than one may be selected):

INNOVATION: Nimble, creative and unique approaches to identifying, responding to, and meeting member needs

IDENTITY: Shared enthusiasm and pride about being an internist and ACP member

ENGAGEMENT & INCLUSION: Actively engaging members in local, regional, and national College activities across their career, welcoming and hearing all voices, and demonstrating ACP’s relevance and connection to what’s important to them

COMMUNICATION: Conveying ACP’s broad mission, activities and value to members, the greater community of internal medicine, and other stakeholders using leading‐edge modalities, platforms and technologies

Describe how your Affinity Group will support and further the/these strategic themes:

Select your proposed first-year activities from the list of opportunities available below. (Choose all that apply.)

Upon approval of the Affinity Group, a detailed first year activities plan will be required to include specific tactics towards engaging members of the group and aligning with the strategic themes of the College

Facilitate opportunities for networking

Serve as a depository of resources around the goals of the group

Foster continuing professional development activities

Identify gaps in existing ACP programming around topics of interest to the group

Provide input, upon request, to ACP staff and governance

Provide an avenue to speak as a unified voice and shared experiences

Provide a pathway for professional leadership development within the organization

Other

The criteria used to consider a proposed Affinity Group include:

Is the steering committee comprised of current ACP members who do not hold an existing leadership role within the College?
Is the group and its goals consistent with ACP’s mission, core values and established policies?
Does the group help to advance ACP’s priority themes and strategies?
Is the group already represented by the current ACP Board of Regents approved committees and councils?
Is the expected membership limited by geography or employment by a single entity?
Do the goals of the group overlap with those of an existing group?
Has the steering committee affirmed that it has read and agrees to comply with the requirements as outlined in the Affinity Group Operations Manual?

Submitter Name:

Submitter Email: