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ATA_Fellows_App_2011

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					                       American Telemedicine Association College of Fellows

Each year ATA elects Members of distinction as new Fellows. Election to the American Telemedicine
Association College of Fellows is a high honor that recognizes significant achievements in telemedicine,
service to the general telemedicine community, and service to ATA.

In order to be considered for election to Fellowship, the following requirements must be met:

   1. A minimum of eight years of membership (student, regular, institutional, corporate) in ATA;
   2. Significant contributions to the field of telemedicine such as publishing significant research,
       serving in a leadership post of a company, institution or governmental program involved in
       telemedicine or playing a significant role in innovation in the field; and
   3. Service to the American Telemedicine Association (e.g., SIG/Chapter leadership, SIG/Chapter
       Member, Committee membership or Board of Directors).

A committee composed of members of the College of Fellows determines election to the Fellowship.

   1) Nominations: College of Fellows application packets must be submitted by February 15, 2011
       to Jennie Shaw at jshaw@americantelemed.org or via fax at 202.223.2787. Self nominations are
       welcome. Submissions must include:

                    Nominee’s Name
                    Nominee’s Contact Information
                    Completed Fellowship Application (including personal statement)
                    Nominee’s CV
                    Two Letters of Recommendation from ATA sponsors. Sponsors may be ATA
                       Fellows, or past/present members of the ATA Board of Directors

       Incomplete application packets will not be reviewed by the committee. Please contact ATA
       sponsors with sufficient time to complete recommendation letters by the application deadline.
2) Fellow Class Size: Each class of ATA Fellows will be announced at the Annual Meeting. Each
   year, up to 0.5% of the current ATA membership may be elected as new Fellows (e.g. 10 out of
   2,000). Fellows are elected for life. Posthumous fellows will not count toward the annual limit.
3) Confidentiality: The identity of the applicants and all application materials will be kept
   confidential by the ATA Office and Board designated Fellowship Committee and once submitted
   become the property of ATA. Applicants who are not selected may reapply in future years.
4) Fellow Designation: Each Fellow is to be known as an American Telemedicine Association
   Fellow and is entitled to use the acronym ATAF after his or her name.
5) Voting: All active Fellows are entitled to one vote per applicant during the annual voting
   process.
6) Election Requirements: No Fellow may be elected with less than 75 percent favorable votes of
   the sum of the favorable and unfavorable votes cast.
7) Notification: All applicants will be notified of Fellow status prior to the annual meeting.
   Notifications will be sent via mail to the address listed on the fellow application.
                                  ATA Fellowship Application Form

ATA members may be elected to the College of Fellows in recognition of significant contributions to the
field of telemedicine and service to ATA. A minimum of eight years of membership (student, regular,
institutional, corporate) in ATA is required. Individuals who might qualify are invited to submit a
Fellows application packet to include: application form, CV, personal statement and two letters of
recommendation from sponsoring ATA Fellows or past/present members of the ATA Board of
Directors. Materials must be submitted to Jennie Shaw at jshaw@americantelemed.org or via fax at
202.223.2787 by February 15, 2011.

   1. Name _______________________________________________________
             LAST                            FIRST                  MIDDLE

   2. Degrees earned ________________________________________________
   3. Mailing Address
       ________________________________________________________________________
       ____________________________________________________________
   4. Phone___________________________               Fax___________________________
   5. E-Mail____________________________________________________________
   6. ATA Member Since __________(year)
   7. List your 3 top contributions to telemedicine and/or service to the ATA:
           a. ___________________________________________________________
           b. ___________________________________________________________
           c. ___________________________________________________________
   8. On a separate sheet (1500 words maximum), please prepare a personal statement that describes
       your contributions to the field of telemedicine to include those contributions outlined in #7.
       Please include citations as appropriate.
   9. Name of ATA Sponsor #1______________________________________________
   10. Name of ATA Sponsor #2______________________________________________
Each year the ATA will select up to 0.5% of the ATA membership as Fellows and new Fellows will be
announced at the Annual Meeting. Unsuccessful applicants may reapply with updated application
materials (including letters of support) in future years. You will receive notification that your application
has been received and a letter notifying you whether or not you have been elected to the ATA College of
Fellows prior to the Annual Meeting.

The identity of the applicants and all application materials will be kept confidential by the ATA Office
and Board designated Fellowship Committee and once submitted become the property of ATA.




______________________________________                ____________________________
Applicant’s Signature                                 Date



   ATA Fellow Committee Only

   Action: Approved _________________             Disapproved________________

   Signature_______________________________________________________

   Comments:_____________________________________________________
   ______________________________________________________________
   ______________________________________________________________

				
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