RFS Council Positions Nomination Form

Applicant information

Of the information collected in this section of the application, only your name, credentials, and pronouns (if any selected) will be made available online for review by members of your Section and other AMA Members.
Name

First NameMiddle NameLast Name
Credentials
Physical mailing address

Street Address

Street Address Line 2

CityState

Zip Code
Date of birth

MonthDayYear
Place of Birth
Email
example@example.com
Primary phone number

Area CodePhone Number
Office phone number

Area CodePhone Number
Medical School
Year Graduated

Please continue
Select the position for which you are seeking Resident and Fellow Section (AMA-RFS) endorsement

AMA-RFS application
Program name
Program year
Program location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Expected program completion date

MonthDayYear
Date
What is your medical specialty?
Please read section V.D. of the AMA-RFS Internal Operating Procedures for an overview of our campaign rules.
I have read and agree to abide by all campaign rules as outlined in the RFS Internal Operating Procedures.

Please continue
Are you an AMA member?
Are you a member of the AMA House of Delegates?
Do you agree to serve in the position for which you are applying?
Board certifications
Please provide a statement of interest that describes what you are looking to accomplish in this position and highlights current/previous leadership experiences that are relevant to this position (250 words max)

up to 250 words0/250
Professional headshot (optional)

Browse Files
.JPEG or .PNG only; Please save file " Your last name_headshot" Cancelof

Endorsements, letters of support, and curriculum vitae

These files will be published online as part of your application for review by AMA Members. Please remove any personal contact information or private details that you do not wish to be shared.
List endorsing organizations (optional)
Applicants have the option, but are not required, to upload up to two recommendation letters / letters of endorsement (optional).

Browse Files
.PDF only. Please save files as "Your last name_Name of endorsing org_Endorsement" or "Your last name_Name of recommending indvidual_Recommendation" Cancelof
Endorsed by
Council or committee
Email
example@example.com
Upload curriculum vitae

Browse Files
.PDF only. 3 pages max. If submitting a longer CV, only the first 3 pages will be published. Please save file as "Your last name_CV" Cancelof

Please continue
I understand that endorsement is not required for this position. The RFS Assembly will endorse one candidate for the resident seat. The election will be held at the House of Delegates (HOD) in June 2027. Any and all candidates may wish to continue their candidacy at the HOD regardless of whether they receive this endorsement.
Current Professional Position and Responsibilities with dates of service. (i.e., practice, administrative, research, academic).
Current/Prior National, State, and Specialty Medical Society Memberships and Affiliations, and Faculty Appointments. (List current and past roles and positions held and dates of service that pertain to this position.)
Current/Prior Membership on AMA Councils/Committees:
Applicant’s Statement of Interest and what you bring to the position.

Not more than 100 words0/100
Applicant’s Statement of perspective and experience.

Not more than 100 words0/100

Click "submit" below to finalize and transmit your application. You will receive an email confirmation with a copy of your application and all submitted documents or files.

Please direct any questions to RFS@ama-assn.org.
Should be Empty:

Applicant information