Application for Fellowship

Please fill in the fields below. When completed hit submit.

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Fellowship Requirements

Fellows:
  1. Rights and Privileges. Fellows shall enjoy all the rights and privileges of members in good standing.
  2. Qualifications. Members of the Association in good standing 1) who have been Clinical Members for five years, unless this requirement is waived by unanimous vote of the Board of Directors; and 2) whose outstanding performance in the field of group psychotherapy has been demonstrated by leadership in organizational service as well as excellence in one of the following areas: II-A) Clinical Practice and Administration; II-B) Teaching; II-C) Research; and II-D) Publications.
I. General Leadership (if additional space is needed, please attach a separate sheet):
A. Offices Held
Offices HeldOrganizationDates
B. Committee/Task Force Participation
Chair/Member/AGPA Representative (Specify Role and Committee)OrganizationDates
C. Promotion of Group in Other Domains (Government, Industry, Education, etc.)
Activities (Describe)OrganizationDates
D. Group Therapy Related Awards and Honors
Name of AwardOrganizationDates
E. Group Psychotherapy Presentations at Professional Meetings (Identify type of presentation: Institute, Workshop, Seminar, Core Course and List Title)
PresentationLength of PresentationOrganizationDates
II. Please identify ONE additional category cited below for which you have demonstrated excellence and list these specific activities with associated dates using the format outlined for previous items.
* Activities reported in category I (General Leadership) may not be duplicated in category II-B (Teaching and Training)--choose one.
III. Please identify any additional experience which you would like the Fellowship and Awards Committee to consider.
IV. Names and addresses of two fellows of AGPA who have agreed to endorse your application (please append letters of reference to the application).
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V. Please send a copy of your curriculum vitae with this application. Information on the curriculum vitae will not be accepted as a substitute for completing the above information; it is an addendum to the application.
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