AARCC Membership Application: FIT

AARCC Membership Application: FIT

Thank you for your interest in joining the Alliance for Adult Research in Congenital Cardiology (AARCC) as a Fellow in Training. Your application will be reviewed by the AARCC Board of Directors, and you will be notified of the outcome. If you have any questions during the process, please don’t hesitate to reach out to us at aarccexec@gmail.com.
Applicant Information
Name*

First NameLast Name
Institution*
Training Year*
Title/Position*
Email*
Please enter your preferred contact information for AARCC communications
Phone Number*
Please enter a valid phone number
Address*

Street Address

Street Address Line 2

CityState

Zip Code

Training and Practice Details
Please specify your ACHD interests, goals, and training
Name & credentials of the ACHD provider at your institution who serves as your mentor*
Do you have a research assistant?*
Number of research assistants*
Percentage of time*
Do you have protected research time?*
Percentage of time*
Program Details
Number of ACHD-specialized MDs*
Number of dedicated ACHD Fellows*
Number of midlevel providers*
Electronic database*
If your program does not use an electronic database, enter "N/A"
On an annual basis, how many patients are seen at your program?
Outpatients*
Inpatients*
On an annual basis, how many procedures are performed at your institution?
Adult congenital cardiac surgeries*
Adult congenital catheterizations*
ACHD electrophysiology studies*

Publications
Have you published any research in the past 5 years?*
List of publications/abstracts in the past 5 years*
Include titles, publication names, and PubMed links if applicable
Research
Have you participated in any research projects in the past 5 years?*
Ongoing research projects*
Please include project titles and collaborators. If not applicable, please enter "N/A"
Ongoing multi-center projects*
List the project titles and describe your role. If not applicable, please enter "N/A"
Previous multi-center projects*
List the project titles and describe your role. If not applicable, please enter "N/A"

Upcoming AARCC Research

As a requirement to join AARCC, we ask that all participants be involved in an AARCC study. Options are to submit a research proposal with this application or to review the existing protocols on the AARCC website (www.aarcc.net). Templates for AARCC research protocols are also listed on the website. New protocols will be reviewed by the protocol committee and then presented to the group.
Please indicate your preference*

I have attached a research proposal I would like to lead through AARCCI am interested in participating in an existing AARCC research study
Research proposal*

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Which protocol(s) would you like to participate in?*
Please share anything else you would like us to know.
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Applicant Information