AADPRT - Registration

IMPORTANT: DATA WILL BE USED TO INFORM INCLUSIVE AND EQUITABLE PRACTICES. ANY DATA SHARED WILL BE DE-INDENTIFIED – YOUR NAME AND CONTACT INFO WILL NEVER BE SHARED.

Program accreditation status:

ACGME accredited
NOT accredited, but has applied with ACGME
Unable to be accredited by ACGME (e.g. community psychiatry fellowship, etc.), but is sponsored by an ACGME-accredited General Psychiatry program that is an AADPRT member.
None of the above, but I am a psychiatrist involved in psychiatric education.

Institution Dues are/will be paid for current member year:

Yes No

These are separate from TD/ATD/Chair/Vice Chair Individual Dues and are paid by the Program Administrator (Coordinator) when they create/renew their account. No charge for subsequent PAs who register/renew.
Benefits:

Allows PA access to helpful resources for managing the program (VTO, listserv, mentorship, etc.)
Lowers PA Annual Meeting registration fee
Lowers TD/ATD/Chair/Vice Chair, etc. membership fee

I am a:

Psychiatrist who is a TD/ATD/Chair/Vice Chair
Psychiatrist who is not a TD/ATD/Chair/Vice Chair and who has an active role in psychiatry education
Psychologist
Program Administrator

I am a psychiatrist involved in residency training:

Yes No

The program administrator (coordinator) of your institution’s General Psychiatry program is a member:

Yes No

I am a:

Psychiatrist
Psychologist
Program Administrator

I am a psychiatrist involved in residency training:

Yes No

Your institution is located in the United States or Canada:

Yes No

I qualify as an Emeritus Member:

Yes No

I have ceased my scientific or medical occupation for which I received remuneration (i.e., income based on professional services has ceased or is less than 10% of full-time occupational income). Upon approval by the AADPRT leadership, an Emeritus Member will have their annual membership dues waived.

Based on your answers, your membership category is:

Affiliate member (must be a psychiatrist)

Emeritus member

International member

Program Administrator (ACGME-accredited program)

Program Administrator (non-accredited program)

Psychiatrist (ACGME-accredited program)

Psychiatrist (non-accredited program)

Psychologist (ACGME-accredited program)

Psychologist (non-accredited program)

Degree (check all that apply)

Board Certifications (check all that apply):

Addiction

CAP

Consult-Liaison

Forensics

General

Geriatrics

N/A

Other

Other Please Specify:

I am an International Medical Graduate (IMG):

Date Of Birth:

Gender:

Female

Male

Non-binary or non-conforming

Other

Prefer not to answer

Other Gender Please specify:

Preferred Pronoun:

He/Him/His

She/Her/Hers

They/Them/Their

Ze (gender neutral, third person, single subject pronoun)

Other

Prefer not to answer

Other Pronoun Please Specify

Sexual Orientation:

Bisexual

Gay

Lesbian

Straight

Other

Prefer not to answer

Other Orientation Please Specify

Race:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian & Other Pacific Islander

White

Prefer not to answer

Prefer to self-describe

Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

Prefer not to answer

Program URL

Example: http://www.example.com

Business Address

Cell Phone

AADPRT sends about 12 text messages per year about ONLY mission-critical information. By providing your cell phone number, you agree to receive these text messages. Message and data rates may apply. AADPRT will never share your phone number with a third party. Consent is not a condition of purchase. Reply STOP to opt out at any time.

Current Role(s) (check all that apply)

Year started in current role (AADPRT Affiliate Member (psychiatrist who’s NOT an educator in a residency program))

Year started in current role (Addictions Psychiatry TD/ATD)

Year started in current role (Career Medical Educator)

Year started in current role (Child/Adolescent ATD)

Year started in current role (Child/Adolescent TD)

Year started in current role (Combined Psychiatry/Family Practice TD/ATD)

Year started in current role (Combined Psychiatry/Medicine TD/ATD)

Year started in current role (Combined Psychiatry/Neurology TD/ATD)

Year started in current role (Consult-Liaison TD/ATD)

Year started in current role (Department Chair)

Year started in current role (Department Vice Chair)

Year started in current role (Division Chief - C&A Psychiatry)

Year started in current role (Fee Waived (Honorary Member, Emeritus Member))

Year started in current role (Forensic Psychiatry TD/ATD)

Year started in current role (General Psychiatry ATD)

Year started in current role (General Psychiatry TD)

Year started in current role (Geriatric Psychiatry TD/ATD)

Year started in current role (Non-Member - Billing/Office Staff)

Year started in current role (Other Sub-Specialty TD/ATD)

Year started in current role (Post-Pediatric Portal TD/ATD)

Year started in current role (Psychologist Involved in Psychiatric Residency Training)

Year started in current role (Residency Program Administrator (Coordinator))

Year started in current role (Triple Board TD/ATD)

Your professional title at program

I want to be a:

Mentor (to resident award winners, fellow TDs, fellow PAs)

Mentee

Program size (general TD/ATD) or fellowship program size (subspeciality TD/ATD):

Program type:

Community-based

Community-based, university-affiliated

University-based

Other

Program Setting:

Rural

Suburban

Urban

Are you the designated voter for your institution? This designated person votes on AADPRT Bylaws and Policy changes.

No Yes

Is this your first year in the position?

Yes No

When did you start current position?

There is already a designated voter for your institution. Are you sure you want to change this?

No Yes

Would you like to purchase a subscription to the Academic Psychiatry Journal for $88?

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