American Surgical Association Surgical Leaders Fellowship Grant

Society of University Surgeons Application Form

The Fellowship Grant covers in part a two-week travel period and pays a grant to the Fellow’s institution of $5,000 ($2,500 each from the ASA and the SUS). The Fellowship grant is ideally suited for mid-level or senior academic surgeons with leadership training who seek a future leadership role and are at the stage in their career to benefit from exposure to a leadership shadowing experience.

Nominations are due May 31, 2022. Three names will be sent to the ASA by June 30, 2022 who will select a primary Fellow and an alternate by August 15, 2022 and notify the candidates and the SUS.

Full Fellowship Grant details are available at americansurgical.org/awards_FellowshipGrant.cgi.

APPLICANT INFORMATION
Name*
First MI Last Degree(s)
Professional Title*
Institution*
Office Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Email*
Fellowship Requirements*
The fellowship requirements include:
Rank of Associate Professor (for a minimum of 3 years) or Professor
Board certification
SUS Member (in good standing)
The candidate must have had either: educational courses in leadership either from the home institution or a national organization such as the ACS, SUS, AAS, SBAS, AAMC, etc.; or be enrolled in or have completed an MBA program.
SUPPORT MATERIALS
With this application, you must submit:
Personal Statement, maximum 500 words (two double-spaced pages), describing what you want to achieve from the Fellowship experience (e.g., what your career goals are, how you have trained so far, and what you hope to get out of the Fellowship)
Preliminary Fellowship Itinerary, including names of proposed ASA members who have or will ask to serve as host leaders
Curriculum Vitae, including picture and bibliography
Letter of recommendation from Department Chair guaranteeing your availability to travel in the Fellowship year and the coverage of expenses in excess of the $5,000 grant
Letter of recommendation from a member of the SUS.
ALL FILES MUST BE IN PDF FORMAT.
Personal Statement*
Accepted file types: pdf, Max. file size: 512 MB.
Preliminary Fellowship Itinerary*
Accepted file types: pdf, Max. file size: 512 MB.
Curriculum Vitae*
Accepted file types: pdf, Max. file size: 512 MB.
Letter of Recommendation from Department Chair*
Accepted file types: pdf, Max. file size: 512 MB.
Letter of recommendation from a member of the SUS*
Accepted file types: pdf, Max. file size: 512 MB.

Society of University Surgeons Application Form

APPLICANT INFORMATION

SUPPORT MATERIALS