ADVOCACY AMBASSADOR PROGRAM - we need YOU!

[Andrew_Doan]

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Members do not see this ad.

This program opened new doors for me, and I encourage residents to participate!

ADVOCACY AMBASSADOR PROGRAM

AMERICAN ACADEMY OF OPHTHALMOLOGY
April 5-8, 2006 MID-YEAR FORUM
JW MARRIOTT HOTEL / WASHINGTON, D.C.

TEMPLATE NOMINATION FORM​

Instructions (Contact Gail Schmidt ([email protected]) for the forms in Word Format):
This nomination will be reviewed by leadership of the (LIST STATE SOCIETY). Please print legibly or type the information requested.

RESIDENT TRAINING PROGRAM DIRECTOR: PLEASE COMPLETE SECTION A
RESIDENT NOMINEE: PLEASE COMPLETE SECTION B

DESCRIPTION OF PARTICIPATION:

In the third year of a pilot effort, the American Academy of Ophthalmology is partnering with state ophthalmological societies and training programs to include residents as special guests at the Mid-Year Forum through its Advocacy Ambassador Program. In 2004, 14 residents attended and in 2005, 40 residents registered to attend the Academy’s Mid-Year Forum through this effort. As part of residents’ participation in the Academy’s Advocacy Ambassador Program, residents are expected to return to their training programs and present their experiences to their colleagues. The $150 Mid-Year Forum registration fee is waived for residents.

The American Academy of Ophthalmology’s Mid-Year Forum is made up of three components.
A. Congressional Advocacy Day – Dinner Briefing & Congressional Visits
Wednesday, April 5 (Dinner Briefing) / Thursday April 6 (Congressional Visits)
Congressional Advocacy Day begins with a dinner briefing on Wednesday April 5, 2006. At this briefing, residents will learn about the key priorities for ophthalmology and medicine which will prepare them for visits with U.S. senators, representatives and healthcare staff to present the concerns and positions of the Academy and the profession. These Congressional visits are arranged by the Academy's Washington D.C. staff and are based on residents’ mailing zip code. When making these Congressional visits on Thursday, April 6th, residents will be joined by ophthalmologists from their area who are leaders in ophthalmic state, subspecialty or specialized interest societies who will serve as their mentors during the visits. Following the dinner briefing on Wednesday, all residents in attendance will be invited to informally gather with Academy leaders who work with the state ophthalmological societies and discuss any questions the residents may have.

B. Mid-Year Forum (MYF) (Thursday, April 6 – Friday, April 7)
The Mid-Year Forum officially kicks off with an Opening Session at 3:00pm on Thursday, April 6, 2006 following Congressional Advocacy Day visits. The MYF is an annual meeting in which leadership of the Academy and allied organizations (ophthalmic state, subspecialty and

specialized interest societies) meet to identify and discuss critical issues facing ophthalmology in order to provide input and advice to the Academy Board of Trustees. Mid-Year Forum attendees include the Academy's Board, Academy committee chairs and representatives to outside organizations (e.g. the AMA, the American College of Surgeons, etc.) as well as officers and executive directors from state, subspecialty and specialized interest societies. The Mid-Year Forum session officially concludes at 2:30pm on Friday, April 7.

C. Council Meeting (Friday, April 7 – Saturday, April 8)
The Academy's Council meeting begins at 3:30pm on Friday, April 7. The Council serves as the advisory body to the Board of Trustees and provides recommendations for board action based on membership concerns. The Council is comprised of two groups: one representing state ophthalmology societies and another representing ophthalmic subspecialty and specialized interest societies. The Council brings recommendations to the Board via Council Advisory Recommendations (CARs). You are encouraged to attend the Council Opening Session on Friday afternoon. The Council meeting will conclude at 2:30pm the afternoon of Saturday, April 8, 2006*.
*IMPORTANT NOTE: THE OPHTHALMIC KNOWLEDGE ASSESSMENT PROGRAM (OKAP) EXAM FOR RESIDENTS COINCIDES WITH THE SATURDAY PORTION OF THE ACADEMY’S COUNCIL MEETING IN 2006. In the future, these two meetings will not conflict. The Academy has arranged for an OKAP testing site at the Mid-Year Forum hotel to accommodate those residents who wish to participate in the Mid-Year Forum . Program Directors must inform the American College of Testing (ACT) in writing as to the resident(s) who plan to take the OKAP at the Mid-Year Forum hotel.

D. Social Events
The Academy will recognize residents in attendance at the Mid-Year Forum during the Welcome Reception and Dinner at the JW Marriott Hotel on Thursday, April 6, 2006. Residents are kindly requested to attend as special guests. In addition, residents will also participate at the Thursday lunch on Capitol Hill following their Congressional visits.

SECTION A (to be completed by resident training program director or department chair)

NOMINEE PROFILE

Training Program: _________________________________________________________

Name of Resident Nominee: _____________________________________________________________________

Nominee’s Mailing Address: ________________________________________________________
_______________________________________________________________________

Nominee’s Phone: ________________ Nominee’s E-mail: __________________________

Nominee’s FAX: __________________



Please list the name(s) and the title(s) of the individuals submitting this nomination on behalf of
your resident training program.

Name: ___________________________________________________________________

Title: ____________________________________________________________________

Address: _________________________________________________________________

Phone: ___________________________________________________________________

E-mail ___________________________________________________________________


If this resident from my program is selected to participate in the Advocacy Ambassador Program, I agree:
a. to allow time following the Mid-Year Forum for the resident to give a presentation to fellow residents regarding his/her experiences and lessons learned.

b. to notify American College of Testing (ACT) in writing if this resident(s) is selected and plans to take the OKAP exam at the Mid-Year Forum hotel

__________________________________ ______________________________
Signature of Program Director Date


SECTION B (to be completed by nominee)

I. Please describe your interest in attending, as a special guest, the American Academy of Ophthalmology’s 2006 Mid-Year Forum in Washington, D.C. via the Advocacy Ambassador Program.

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________




II. In a 200-word statement, please indicate why you should be selected by the (LIST STATE OPHTHALMOLOGICAL SOCIETY) to participate as a sponsored guest in the Advocacy Ambassador Program (i.e. INSERT BY STATE SOCIETY -- list the expenses that your state society agrees to cover such as economy airfare made within X time of meeting, days of lodging and related expenses covered). Please attach your CV.

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________


AAO Member?* YES ________ NO________
(*Note: Participants attending the Mid-Year Forum must be members of the American Academy of Ophthalmology. AAO membership is FREE for residents and is completed by filling out an application signed by a program director. The Academy member-in-training membership application is available online at http://www.aao.org/about/membership/mit.cfm)

(INSERT NAME OF STATE SOCIETY) Member ?* YES ________ NO________
(*Note: The (List state society) waives dues (or charges a nominal $$$) for resident’s membership dues)

If selected, I agree to:
a. participate in all designated elements of the Mid-Year Forum. (i.e., attend all meetings except those that conflict with the OKAP exam)

b. provide a presentation at my training program regarding my experiences and lessons learned at the Mid-Year Forum.

c. provide (list state society) a brief synopsis of my experiences at the Mid-Year Forum for publication in (list state society) newsletter or other society publication (optional – to be determined by state society).


__________________________________ ______________________________
Signature of Resident Nominee Date




Please return the completed nomination form and CV by XX, 2006 to (DETERMINE THE DATE BY WHICH YOUR SOCIETY NEEDS TO RECEIVE. KEEP IN MIND THAT RESIDENTS WHO WANT TO TAKE THE OKAP EXAM AT THE MYF HOTEL NEED TO HAVE THE PROGRAM DIRECTOR SUBMIT THE NAME OF RESIDENT(S) IN WRITING TO THE TESTING GROUP, AMERICAN COLLEGE OF TESTING, BY FEBRUARY 28, 2006)

(INSERT STATE SOCIETY EXECUTIVE DIRECTOR NAME
And State Society Address)

 

[Andrew_Doan]

*IMPORTANT NOTE: THE OPHTHALMIC KNOWLEDGE ASSESSMENT PROGRAM (OKAP) EXAM FOR RESIDENTS COINCIDES WITH THE SATURDAY PORTION OF THE ACADEMY’S COUNCIL MEETING IN 2006.

In the future, these two meetings will not conflict. The Academy has arranged for an OKAP testing site at the Mid-Year Forum hotel to accommodate those residents who wish to participate in the Mid-Year Forum . Program Directors must inform the American College of Testing (ACT) in writing as to the resident(s) who plan to take the OKAP at the Mid-Year Forum hotel.

 

[Andrew_Doan]

I strongly suggest residents get invovled with this program. This opens doors to you and your career.