Skip survey header

NAOME - Fellowship Application

NAOME Portfolio Submission (you should already have your material prepared)

By submitting this Application, you are attesting to the following:
  • I have carefully reviewed the Fellowship Standards and Expectations
  • I have at least 5 years of sustained excellence in osteopathic medical education
  • I have reviewed the Scholarship Categories and utilized the guide to help me in selecting the correct category
  • I have obtained the appropriate signature on the Reference Check Form from my COM
  • I understand that current NAOME Fellows are available for guidance with my portfolio 
  • I have read the Portfolio Preparation material, downloaded the appropriate templates and prepared material to upload for this application

 

1. Contact Information *This question is required.
3. Dean Contact Information
4. What fellowship category are you applying for? 
5. I have discussed this decision with an appropriate official from my COM, attached is the reference form. 
6. Upload Portfolio with appendices as one file (not to exceed 25 pages)
7. Upload CV
8. Have you had any disciplinary or adverse action imposed against any professional license or by an institutional governing board, or were you denied professional license, or have you entered into any consent agreement, stipulated order or settlement with any regulatory board; OR have you been notified of any complaints or investigations against your license that have not yet been resolved and/or have you been notified of any institutional disciplinary actions that have not yet been resolved? 
9. I affirm that all the information included in my submitted academic portfolio is accurate.  
 
Clear
Signature of