SAGES Fellowship Certification Application

The SAGES Fellowship Certificate is intended to verify that an individual has successfully completed his/her fellowship training and is an exemplary general surgeon with special qualifications in either Advanced GI/MIS, Flexible Endoscopy, or both. Certificates will be awarded at the SAGES Annual Meeting and recipients names posted on the SAGES website.

SAGES encourages those completing their fellowship training in the 2017-2018 academic year to open their application before the July 31, 2018 deadline. You will then have two years – from the end of your fellowship or from Board Certification, whichever comes first – to finish the application.

1. To open your application, simply fill out the online form at Fellowship Certification and pay the $100 application fee.
2. Once we receive your application and payment, we will send you an email to complete the remaining steps:

1. - Obtain full Active membership in SAGES. If you’re currently a SAGES candidate member, please log onto your membership page and click here to learn how to upgrade to Active Membership. Not yet a SAGES Member? Join here!
  - Upload your Fellowship Council Case Log in CSV/Excel format showing minimum case numbers have been met
  - Upload a copy of an abstract submitted to a major meeting during your fellowship
  - Upload a CME certificate or copy of a badge from a major meeting attended during your fellowship
  - Upload copies of FLS and FES (both required)
  - Upload a copy of FUSE certificate. (*FUSE is optional but strongly encouraged for 2017-2018 fellows and will be required beginning with the 2018-2019 fellowship year)

Application reviews will take place in November 2018 and February 2019. For questions or more information, please email Vanessa Cheung

2018 SAGES Certification of Fellowship Training Application

I hereby request a SAGES Certificate of MIS Fellowship Training
First Name*
Enter information EXACTLY as they are to appear on the certificate
Last Name*
Degree(s)
Email*
Cell Phone*
Send the Certificate To*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I am applying for SAGES Certification in*
- Advanced GI MIS
- Flexible Endoscopy
- Both
Residency Program and Year of Completion*
Fellowship Program and Year of Completion*
Type of Fellowship, please select one the following program types. [note: Bariatric fellowship is not eligible for this application]*
- Advanced GI MIS
- Advanced GI MIS/Bariatric
- Advanced GI MIS/Bariatric/Flexible Endoscopy
- Advanced GI MIS/Flexible Endoscopy
- Flexible Endoscopy
Is this program accredited by the Fellowship Council*
- Yes
- No
Sorry

In order to complete the application for SAGES certification of your fellowship, the Fellowship Program MUST be accredited by the Fellowship Council and also be in good standing.

Please exit this application now and check with your Fellowship Program or the Fellowship Council to verify program status.
Fellowship Program Director Name (SAGES will invite your Program Director to complete an online survey)*
First Last
Fellowship Program Director Email*
Are you a SAGES Member?
- Yes
- No
If you're not a SAGES member, please join here
Year of SAGES Membership*
Enter a single 4-digit year only.
Are you a SAGES Active Member?
- Yes
- No
If you are not yet an Active member, please upgrade now to be eligible for certification. For additional information, please email SAGES Membership Coordinator.
Year of conversion to Active SAGES membership
Payment
Fellowship Certification Application Fee
Total Due on Submission
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Authorization for Release of Information
Authorization*
- By checking this box, I authorize the Fellowship Council and the above named Fellowship Program(s) to share confidential information only as relevant to this application with SAGES. I additionally authorize SAGES to obtain confidential information only as relevant to this application from the Fellowship Council and the above named Fellowship Program(s) and hold these parties harmless for any damages resulting from this exchange of information.
Name
This field is for validation purposes and should be left unchanged.

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544