FY 2023 APDIM Provisional
Membership Application

(July 1, 2022 to June 30, 2023)

Internal medicine residency programs that have started the accreditation process and have not received initial or continued accreditation from the Accreditation Council for Graduate Medical Education (ACGME) or the Royal College of Physicians and Surgeons of Canada (RCPSC) are invited to join APDIM on a provisional basis. APDIM provisional program dues are $1,880 per year and include the residency program director and any additional faculty and staff involved in the internal medicine residency program. All new applications must be reviewed and approved by the APDIM Council before membership is granted.

If your program has already received ACGME or RCPSC initial accreditation and would like to join, please email memberservices@im.org or call (703) 341-4540 to receive the appropriate membership dues invoice.

Learn more about APDIM

Please use proper capitalization when completing the form. Fields marked with an asterisk must be completed.

Residency Program Information

Email address of person completing this form *

Program Name *

Department

Affiliated Medical School (If Applicable)

Program Email Address *

Address 1 *

Address 2

City *

State/Province *

ZIP Code *

Phone *

Fax

Additional Residency Program Information

When did your program begin the accreditation process? *

What level of accreditation does your program hold? *

When is the projected date of full accreditation? *

Have you begun to interview/accept residents? *

Yes

No

If yes, how many residents are affiliated with your program?

In addition to internal medicine, what other graduate medical education programs are offered at your instititution? *

How often has your program or will your program be reviewed before full accreditation is granted? *

How many faculty are involved in the internal medicine residency program? *

Residency Program Director Information

Program Director Name *

Suffix 1 *

Suffix 2

Designations & Certifications

Program Director Email Address *

Address 1 *

Address 2

City *

State/Province *

ZIP Code *

Phone *

Application Process

Your application will be submitted review. Once reviewed, your program will be contacted regarding the status of your application. If approved, please submit payment, as instructed below. After payment is received, your program may enroll members. If you have questions about the application process, please email memberservices@im.org or call (703) 341-4540.

Member Enrollment

Once approved, your program may enroll members online at www.im.org/members/join. In addition to the program director, please enroll all faculty and staff involved in the internal medicine residency program.

Payment Information

The dues amount for APDIM Provisional membership is $1,880. Dues payment covers the program director and all program representatives. Membership dues payment may be made by check or by credit card. If paying by check, please make payable to AAIM and mail to:

AAIM

PO Box 222181

Chantilly, VA 20153-2181

(AAIM's Tax ID number is 27-3063631)

If paying by credit card, please call AAIM Member Services at (703) 341-4540.

FY 2023 APDIM ProvisionalMembership Application