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SAGES Fellowship Certification Application

SAGES Certification of Fellowship Training

Thank you for your interest in obtaining SAGES certification for your Advanced GI/MIS and/or Flexible Endoscopy Fellowship. This form will allow you to apply for SAGES certification but before you begin, please make sure you have the following information and documents on hand:
- Obtain full active membership in SAGES – please upgrade membership prior to application submission
- Your fellowship program director's name and email address
- A recent download of your Fellowship Council Case Log in CSV/Excel format
- A copy of an abstract submitted to a major meeting during your fellowship
- A CME certificate or copy of a badge from a major meeting attended during your fellowship
- Copies of FLS (required)/FES (required)/FUSE (optional) certificates.
- Finished your Fellowship in 2016 or 2015
If you have all of the above handy, click the button below to continue on to the 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
Check all that apply
Residency Program and Year of Completion*
Fellowship Program and Year of Completion*
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*
Fellowship Program Director Email*
Year of SAGES Membership*
Enter a single 4-digit year only.
Year of conversion to Active SAGES membership
If you are not yet an Active member, please upgrade now to be eligible for certification. Contact membership@sages.org for more information.
Meetings where abstracts were submitted during Fellowship Year
- SAGES
- ACS
- DDW
- AHPBA
- Obesity Week
- Other
Other:
Meetings where abstracts were presented during Fellowship Year
- SAGES
- ACS
- DDW
- AHPBA
- Obesity Week
- Other
Other:
Journals where papers were published during fellowship year:
- Surgical Endoscopy
- Surgery
- Journal of Surgical Research
- Surgery for Obesity and Related Diseases
- Journal of the American College of Surgery
- Other
Other:
Annual society meetings, postgraduate courses, or CME-certified hands-on courses attended during fellowship:

Uploads
Please upload the final summary caselog report for this fellow from the Fellowship Council caselog system.
Accepted file types: xls, csv, xlsx.
This report can be downloaded by the Program Director at the following link and must be attached here.
1. Login to your account at www.fellowshipcaselog.org
2. Click "Manage Fellows and View Individual Logs"
3. Click on the name of the fellow to view
4. Look for "Summary Reports Available" and click on “Grouped by Tertiary”; please note this may take a few minutes to create
5. Click on box labeled “Count of Procedures per Third Level Category. Grouped by Type and Role.” This will open up the report within the web page.
6. Click on the link labeled “Export this report to CSV”
7. Save file to your computer
File must be in Excel or CSV format
Please upload at least one abstract that was submitted to a national or regional meeting during the fellowship.*
Accepted file types: pdf, doc, docx.
PDF, DOC, DOCX only.
Please upload a CME certificate or copy of badge from one annual society meeting, postgraduate course, or CME-certified hands-on course.*
Accepted file types: pdf, doc, docx, jpg, jpeg, gif, png.
PDF, DOC, DOCX, JPG/JPEG, GIF, or PNG only.
Please upload your FLS certificate*
Accepted file types: pdf, doc, docx, jpg, jpeg, gif, png.
Please upload your FES certificate
Accepted file types: pdf, doc, docx, jpg, jpeg, gif, png.
PDF, DOC, DOCX, JPG/JPEG, GIF, or PNG only.
Please upload your FUSE certificate
Accepted file types: pdf, doc, docx, jpg, jpeg, gif, png.
PDF, DOC, DOCX, JPG/JPEG, GIF, or PNG only.

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 signing this application, 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.
Information may include summaries of performance-evaluation data and other information relating to your fellowship duties.
Signature

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Email*
Name
This field is for validation purposes and should be left unchanged.

Important Links

Download the 2016 Final Program PDF

2017 Meeting Information

Healthy Sooner: Patient Information

Contact SAGES

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

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SAGES Fellowship Certification Application

SAGES Certification of Fellowship Training

I hereby request a SAGES Certificate of MIS Fellowship Training

Sorry

Uploads

Payment

Authorization for Release of Information

Newsletter Subscriptions

Important Links

Contact SAGES

Words to Live By