Fellowship Application

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1 Fellwship Applicatin Fellwship prvides a means t recgnize excellence, t innvatin and significant cntributins t the medical fitness industry and leadership in the Medical Fitness Assciatin. Eligibility Requirements: Be a member f the Medical Fitness Assciatin fr at least three years; Hld a minimum f a bachelr s degree Attend at least tw Medical Fitness Assciatin annual meetings in the last 10 years Recmmendatins frm tw current Medical Fitness Assciatin Fellws The candidate must pssess 100 service pints t be cnsidered fr eligibility. A minimum f 65 pints must cme frm service t the Medical Fitness Assciatin. Dcumentatin f earned pints must be submitted with the applicatin. A dwnladable checklist is available t assist yu with this prcess. Fellwship Benefits: Organizatinal vting privileges Eligibility t be nminated fr the Medical Fitness Assciatin Bard f Directrs Eligibility t be nminated fr the Medical Fitness Fundatin Bard f Trustees Opprtunity t attend special Fellw nly scial and educatinal events Apprval t use the credential FMFA (Fellw f the Medical Fitness Assciatin) Certificate suitable fr framing annuncing yur Fellwship designatin Criteria: The criteria utlined in Article III, sectin 1 f the Medical Fitness Assciatin bylaws and as defined by the Bard f Directrs f the minimum requirements fr advancement t Fellw status. Fellwship is reserved fr current, r retired, physicians, scientists and healthcare/wellness/fitness prfessinals with a demnstrated interest in medical fitness and whse dcumented accmplishments supprt the stated bjectives f the Medical Fitness Assciatin. At a minimum, candidates must be able t demnstrate that they have met the Fellwship criteria as defined belw. Service pints: Service pints are awarded in three primary categries as fllws: Service t the Medical Fitness Assciatin Active medical fitness assciatin member (1 pint fr each year f active membership) Cmplete a full term service n a MFA cmmittee (4 pints per term f service) Cmplete a full term service n a special prject r task frce (2 pints per prject r task frce) special prjects and tasks fr scripts generally last less than ne year and are appinted by the Bard f Directrs, r the MFA Office. Serve n a writing grup (e.g., White paper, exam item writing, etc.) (2 pints) Serve as a reginal chairpersn (5 pints per year f service) Serve as a State Captain Serve as a faculty member fr the Medical Fitness Institute (4 pints per sessin) Serve as a facility certificatin examiner (lead examiner eight pints per year; secnd examiner (4 pints per year) Achievement f a Medical Fitness Assciatin individual (nt facility) in Distinguished Service Award, Rising Star Award, r ther Medical Fitness Assciatin individual recgnitin (5 pints per award) Attendance that a Medical Fitness Assciatin Annual Cnference (4 pints per year) Presentatin f a Medical Fitness Assciatin Annual Cnference (4 pints per presentatin) Medical Fitness Assciatin Webinar presentatin (4 pints per presentatin) Cnference Assistant Prgram (CAP) at annual cnference (minimum 10 hurs) Attendance at a Medical Fitness Assciatin Reginal Cnference (2 pints per meeting) Presentatin at a Reginal Cnference (2 pints per presentatin)

2 MFA Fellwship Applicatin fr Advancement t Fellw Page # Hst a Reginal Cnference (10 pints designated t the hst site t be distributed amng the hsting members at the discretin f the meeting chair) Hst a Medical Fitness Institute Hst a One-Day State Netwrking Event Service t the Integrated Medical Fitness Field Manuscript publicatin in a peer-reviewed jurnal (2 pints per published paper, nt t exceed 10 pints) Publish an article (first authr) Related t the medical fitness industry in a lay publicatin f natinal, r internatinal scpe and (1 pint per article, nt t exceed 5 pints) Write a chapter (first authr) n a tpic area related t Medical Fitness / Medicine in a published bk (1 pint per chapter, nt t exceed 10 pints) Serve as a reviewer fr a peer-reviewed jurnal, r bk, fcused n tpics related t Medical Fitness/Exercise Science/Medicine (1 pint per year nt t exceed five pints) Serve n a bard, cmmittee, r task frce f an rganizatin (nt Medical Fitness Assciatin) whse missin/fcus is related t the Medical Fitness Industry (1 pint per year nt t exceed five pints) Hld an accredited certificatin (2 pints per current certificatin) Obtain a Master s Degree in a field related t Exercise Science, Health Prmtin, Medicine, Public Health, r Health Care Administratin (MBA r MHA) (5 pints) Earn a terminal degree (PhD, MD, DO, etc.) in a field related t Exercise Science, Health Prmtin, Medicine, Public Health, r Health Care Administratin (10 pints) Cmmunity Service related t the Medical Fitness Industry/Field Present a lay lecture n a tpic related t Medical Fitness (1 pint per lecture, nt t exceed 5 pints) Publish an article in a lcal publicatin related t Medical Fitness (1 pint per article, nt t exceed 5 pints) Leadership rle in a lcal service rganizatin (Rtary, Lin s Club, Kiwanis, Junir League, etc.) (1 pint per year up t 2 pints) Leadership rle in a lcal charitable campaign (United Way, Hspice, etc.) (1 pint per year up t 2 pints) Prcess fr Advancement t Medical Fitness Assciatin Fellw Status Submit a cmpleted applicatin with apprpriate dcumentatin and a $50.00 nn-refundable applicatin fee t the Medical Fitness Assciatin hme ffice. Applicatins will be reviewed by the MFA ffice t ensure the accuracy and cmpleteness f the applicatin. The Applicatin will be frwarded fr review and evaluatin t the Fellwship Review Cmmittee. Upn cmpletin f their review the Fellwship Review Cmmittee will make a recmmendatin t the Bard f Directrs regarding advancement t Fellw. The Bard f Directrs will receive all the applicatin materials and is respnsible fr the final determinatin f a candidate s advancement t becme a Fellw f the Medical Fitness Assciatin. In mst instances, the Bard will act upn the recmmendatin f the Fellwship Review Cmmittee. Hwever, n rare ccasins, additinal infrmatin be available t the Bard f Directrs that may affect the final vte. Under n circumstances will an individual be advanced t Fellw wh has nt met the minimum service pint requirements. The Medical Fitness Assciatin Fellwship is nt anther membership categry, but an industry hnr earned thrugh service t the industry. Fellwship is cnferred n members wh have made significant cntributins t the Medical Fitness Industry and wh are cmmittee t furthering the missin f the Medical Fitness Assciatin. Medical Fitness Assciatin Fellws are required t maintain an active membership in the assciatin. Shuld the assciatin membership lapse, the member may n lnger use, r claim the use f the title, r prfessinal designatin f Medical Fitness Assciatin Fellw and the cncmitant use f the FMFA initials.

3 MFA Fellwship Applicatin fr Advancement t Fellw Page # Frmer Fellws may be cnsidered fr re-instatement under the fllwing cnditins: 1. Fr members whse Fellwship has been expired fr less than ne year, the Fellwship status is autmatically re-instated with the payment f the assciatin s annual dues. 2. Fr members whse Fellwship has been expired fr mre than ne year, the assciatin dues must be paid and a new applicatin fr Fellwship must be submitted and cnsidered. 3. If there are mitigating circumstances, the member may submit, in writing, a letter t the Bard f Trustees requesting re-instatement as a Fellw by giving a detailed justificatin f the mitigating circumstances. The Bard f Directrs will cnsider the letter at its next regularly scheduled meeting if the member is current with his/her membership dues. Appeal letters must be submitted t the MFA Office addressed t the attentin f Fellwship Prcess fr Appealing a Fellwship Decisin Applicants wh are nt apprved fr advancement t Fellwship status, may appeal the decisin, in writing, t the Medical Fitness Assciatin Bard f Directrs. Upn appeal, the Bard will cnvene an appeals cmmittee cnsisting f the Executive Cmmittee and the Chairpersn f the Fellwship Cmmittee t review the appeal. The Appeals Cmmittee may nly cnsider infrmatin prvided in the riginal applicatin alng with any explanatin prvided in the appeals letter. Any new infrmatin prvided will be disregarded by the appeals cmmittee. If the applicant has new infrmatin t add t the riginal applicatin, then the applicatin must be re-submitted fr full review by the Fellwship Review Cmmittee alng with a new applicatin fee. Instructins fr Cmpleting the Applicatin All prtins f the applicatin must be typed, including all letters f recmmendatin. Hand-written applicatins will nt be accepted by the MFA ffice. The Applicatin and Fellw Recmmendatin frms are available fr dwnlad frm the Medical Fitness Assciatin website. Applicatins must be cmplete and any additinal dcumentatin included as necessary t validate the claimed pints. If additinal space is needed t prvide apprpriate infrmatin needed by the Fellwship Review Cmmittee in their evaluatin, separate pages may be attached as an appendix t the applicatin nting the sectin and questin number frm the applicatin t ensure that the cmmittee can crrectly identify where the additinal infrmatin belngs. Prviding detailed infrmatin will minimize any delays in prcessing the applicatin. Applicants may submit their applicatins either n-line by scanning the applicatin dcuments, CV and ther supprting dcuments and ing them t jasn.aslanian@medicalfitness.rg with a cc t bb.bne@medicalfitness.rg. Applicatins may als be submitted in writing my mailing ne cmplete cpy t (n staples please): Medical Fitness Assciatin Attn: Fellwship Applicatin 90 Cherkee Rd Suite 3A Pinehurst, NC Submitted applicatins must include the nn-refundable applicatin fee using the Fellwship Payment Frm. This may be paid by check r credit card. We recmmend that if paying by credit card, the applicant call the MFA ffice (910) t prcess yur credit card in a mre secure manner.

4 MFA Fellwship Applicatin fr Advancement t Fellw Page # **REMINDER: APPLICATION MUST BE TYPED** Cmplete the entire frm. If the space prvided is nt adequate, please nte in the space prvided that an addendum is attached. Applicant Name: Year Jined Medical Fitness Assciatin: Date: (As yu wuld like it t appear n Fellw Certificate) Medical Fitness Assciatin Annual Cnferences attended in the last 10 years: Year Lcatin List tw (2) MFA Fellws wh will submit recmmendatins n yur behalf Educatin: (List mst recent degree first) Institutin Degree Date Awarded List Current Certificatins, Special Certificates, etc.: Certificatin Date Issued Expiratin Date

5 MFA Fellwship Applicatin fr Advancement t Fellw Page # Prfessinal Experience: (last 10 years - list mst recent psitin first) Cmpany Jb Title Dates f Emplyment Service Pints: Service t the Medical Fitness Assciatin Pints Categry Active Medical Fitness Assciatin Member (1 pint fr each year f active service) Cmpleted full term f service n a MFA Cmmittee (4 pints per term f service) Cmpleted a full term f service n a special prject r task frce (2 pints per prject r task frce) Serve n a writing grup (e.g., White paper, exam item writing, etc.) (2 pints) Serve as a reginal chairpersn (5 pints per year f service) Serve as a State Captain (4 pints per year f service) Serve as a faculty member fr the Medical Fitness Institute (4 pints per sessin) Serve as a facility certificatin examiner (lead examiner [8 pints per year]; secnd examiner [4 pints per year]) Achievement f a MFA individual Distinguished Service Award, Rising Star Award, r ther MFA individual recgnitin (5 pints per award) Attendance that a Medical Fitness Assciatin Annual Cnference (4 pints per year) Presentatin f a Medical Fitness Assciatin Annual Cnference (4 pints per presentatin) Medical Fitness Assciatin Webinar presentatin (4 pints per presentatin) Cnference Assistant Prgram (CAP) - prgram includes wrking fr a minimum f 10 hurs with MFA Staff during the Annual Cnference (1 pint per year) Attendance at a Medical Fitness Assciatin Reginal Cnference (2 pints per meeting) Presentatin at a Reginal Cnference (2 pints per presentatin) Hst a Reginal Cnference (10 pints designated t the hst site t be distributed amng the hsting members at the discretin f the meeting chair) Hst a Medical Fitness Institute (10 pints designated t the hst site t be distributed amng the hsting members at the discretin f the meeting chair) Attendance at a Medical Fitness Assciatin State Netwrking event (1 pint per meeting) Ttal MFA Service Pints: Service t the Medical Fitness Industry/Field

6 MFA Fellwship Applicatin fr Advancement t Fellw Page # Manuscript publicatin in a peer-reviewed jurnal (2 pints per published paper, nt t exceed 10 pints Publishe an article (first authr) Related t the medical fitness industry in a lay publicatin f nati internatinal scpe and (1 pint per article, nt t exceed 5 pints Write a chapter (first authr) n a tpic area related t Medical Fitness / Medicine in a published bk per chapter, nt t exceed 10 pints Serve as a reviewer fr a peer-reviewed jurnal, r bk, fcused n tpics related t Medical Fitness/E Science/Medicine (1 pint per year nt t exceed five pints Serve n a bard, cmmittee, r task frce f an rganizatin (nt Medical Fitness Assciatin) missin/fcus is related t the Medical Fitness Industry (1 pint per year nt t exceed five pints Hld an accredited certificatin (2 pints per current certificatin Obtain a Master s Degree in a field related t Exercise Science, Health Prmtin, Medicine, Public He Health Care Administratin (MBA r MHA) (5 pints Earn a terminal degree (PhD, MD, DO, etc.) in a field related t Exercise Science, Health Prmtin, M Public Health, r Health Care Administratin (10 pints Earn the Medical Fitness Assciatin Fitness Facility r Medical Fitness Directr Certificatin (2 pints per certificatin) Ttal Industry Service Pints: Cmmunity Service Presente a lay lecture n a tpic related t Medical Fitness (1 pint per lecture, nt t exceed 5 pints Publish an article in a lcal publicatin related t Medical Fitness (1 pint per article, nt t exceed 5 pints Leadership rle in a lcal service rganizatin (Rtary, Lin s Club, Kiwanis, Junir League, etc.) (1 pint per year up t 2 pints Leadership rle in a lcal charitable campaign (United Way, Hspice, etc.) (1 pint per year up t 2 pints Other Cmmunity Service (Must be apprved by MFA ffice) (1 pint per apprved activity maximum 2 pints) Ttal Cmmunity Service Pints: Grand Ttal Service Pints (MFA + Industry + Cmmunity Service Pints): Please answer the fllwing questin: If advanced t Medical fitness Assciatin Fellw Status, hw will yu exhibit yur cmmitment t the gals and lng range bjectives f the rganizatin (e.g., n which cmmittees are yu willing t serve, what service can yu prvide t yur reginal chapter, in what ther capacity d yu envisin cntinuing t serve the assciatin)? Please be as specific as pssible. [Please insert text here]

7 MFA Fellwship Applicatin fr Advancement t Fellw Page # There is an addendum attached t this applicatin fr the fllwing: Educatin Certificatin Service t MFA Service t Industry Service t Cmmunity Other (Please Specify): Applicatin Final Check List Medical Fitness Assciatin member fr three (3) years r mre Bachelr s r higher degree earned Attended tw (2) r mre MFA annual meetings in the past 10 years Earned a minimum f 100 Service Pints f which include: 65 r mre Medical Fitness Assciatin Service Pints Medical Fitness Industry Service Pints Cmmunity Service Pints Tw (2) current Fellws recmmendatins Typed Applicatin and CV r Resume submitted via r hard cpy $50.00 applicatin fee submitted using Fellwship Payment Frm t ensure prper credit.

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