Program Change Notification

Member Change Form
All major changes to member programs must be submitted in writing to the Fellowship Council office via the Member Change Form. Major changes include:

  • Change in Program Director
  • Significant Change in Faculty Complement
  • Change in Number of Positions Available
  • Change in Program Designation
  • Withdrawal from the Fellowship Council/Program Closure

Fellow Change Form
Programs must complete the Fellow Change Form any time there is a change to either the Matched or Current Fellow.

Change Review Process
The information will be reviewed by the Membership, Communications, Accreditation Committees, and/or Board of Directors as applicable. The form must be signed by BOTH the Program Director and the program’s Designated Institutional Official (DIO).

The completed form must be emailed to Executive Director Yumi Hori at

**Potential triggers for a site visit by the Accreditation Committee include but are not limited to: a change in Program Director, a change in the number of fellows, a significant change in the associate faculty, insufficient case logs, program complaints, failure to address previous citations, and conflicts with the residency program. Please also note that a change in program designation may require closure of the existing program and re-application as a new member for the requested new designation.

Download the Member Change Notification form.

Download the Fellow Change Notification form.