Advancing Pediatric Educator Excellence (APEX) Teaching Program

APEX Teaching Program | Application
Applicant Participation Agreement | Checklist
- CV – Please upload a CV that highlights your background and experience in medical education, any specific training in medical education you have received, and any organizational affiliations relevant to medical education.
- Statement of Interest (max. 500 words) – Please include a description of your current teaching activities, your personal goals for the program, and how participation in the program will benefit you and your institution. Also include how you would contribute to the diversity of the APEX Teaching Program.
- Supervisor Agreement Signature Form - (Download here)
- Mentor Agreement Signature Form- (Download here)
ALL MATERIALS ARE DUE BY:

November 15 (PAS Track)

January 15 (PHM Track)

For Questions: APEXTeachPrgm@aap.org
Applicant Information:
Which program are you applying to:
Name*

First NameLast Name
Title*
Affiliation*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Membership Information: Please indicate if you are a member of one or both of the following organizations.*

American Academy of Pediatrics (PHM track applicants must be a member of the Section on Hospital Medicine to qualify for the discount)American Pediatric Association
Statement of Interest (max. 500 words) – Please include a description of your current teaching activities, your personal goals for the program, and how participation in the program will benefit you and your institution.*

0/500
Please upload your CV

Browse Files

Cancelof
Please upload the Supervisor Agreement (Division Chief, Department Chair, etc)*

Browse Files

Cancelof
Please upload the Mentor Agreement*

Browse Files

Cancelof
My signature below affirms that:
- If accepted into this program, I agree to fulfill all requirements for certification within the timeline presented on the next page.
- I have met with my supervisor and my mentor, and I have discussed with each of them the elements of the program, the expectations for participants and mentors, and the time commitment involved.
- I understand that to earn certification, I must complete all required elements of the program.
- I understand that the tuition for this program is $1,500 ($2,000 for non-members) is payable at the time of acceptance into the program.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

APEX Teaching Program | Application

Applicant Participation Agreement | Checklist

Applicant Information:

My signature below affirms that: